Silver AV87 1808 ($350 Deductible, Low Out of Pocket Maximum, Open Access) – HMO

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	Success Your progress has been saved. We have sent an email to with a link to continue your application ×
Out-of-pocket max	$2,650 per person $5,300 per family
Metal tier	Silver

Visit Copay

Primary care visit	35% coinsurance after deductible
Specialist visit	35% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	35% coinsurance after deductible
Emergency room	35% coinsurance after deductible
Ambulance	35% coinsurance after deductible
Hospital stay (facility)	35% coinsurance after deductible
Hospital stay (physician)	35% coinsurance after deductible
Outpatient procedure (facility)	35% coinsurance after deductible
Outpatient procedure (physician)	35% coinsurance after deductible
Physical rehabilitation	35% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	35% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	30% coinsurance after deductible
Brand	30% coinsurance after deductible
Non-preferred Brand	30% coinsurance after deductible
Specialty	30% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	35% coinsurance after deductible
Imaging (CT/PET/MRI)	35% coinsurance after deductible
Blood work	35% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	35% coinsurance after deductible
Psychiatric hospital stay	35% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://hf.org/2024_sbc_1808.pdf
Drug and medication plan formulary	https://hf.org/MP_formulary_2024
Search doctor list	https://hf.org/MP_directory_2024