Silver 94 Trio HMO – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $5 copay
Specialist visit: $8 copay
Urgent care visit: $5 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $1,150 per person $2,300 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $5 copay |
| Specialist visit | $8 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $5 copay |
| Emergency room | $50 copay |
| Ambulance | $30 copay |
| Hospital stay (facility) | 10% coinsurance |
| Hospital stay (physician) | 10% coinsurance |
| Outpatient procedure (facility) | 10% coinsurance |
| Outpatient procedure (physician) | 10% coinsurance |
| Physical rehabilitation | $5 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 10% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $3 copay |
| Brand | $10 copay |
| Non-preferred Brand | $15 copay |
| Specialty | 10%, up to $150 copay, 10%, up to $150 coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | $8 copay |
| Imaging (CT/PET/MRI) | $50 copay |
| Blood work | $8 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $5 copay |
| Psychiatric hospital stay | 10% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/YX8GBJnwkQ69XkVP4UM2GB1w.pdf |
