Silver Simple CSR 200 – EPO
87% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: $30 copay after deductible
Specialist visit: 15% after deductible
Urgent care visit: 15% after deductible
Description
This plan has 87% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $800 per person $800 per person |
| Out-of-pocket max | $2,600 per person $5,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $30 copay after deductible |
| Specialist visit | 15% after deductible |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | 15% after deductible |
| Emergency room | 15% after deductible |
| Ambulance | 15% after deductible |
| Hospital stay (facility) | 15% after deductible |
| Hospital stay (physician) | 15% after deductible |
| Outpatient procedure (facility) | 15% after deductible |
| Outpatient procedure (physician) | 15% after deductible |
| Physical rehabilitation | 15% after deductible |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | 15% after deductible |
Pharmacy, Drugs, and Medication
| Generic | 15% after deductible |
| Brand | 15% after deductible |
| Non-preferred Brand | 15% after deductible |
| Specialty | 15% after deductible, up to $150 copay, 15% after deductible, up to $150 |
Lab Tests and Diagnostic Procedures
| X-rays | 15% after deductible |
| Imaging (CT/PET/MRI) | 15% after deductible |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 15% after deductible |
| Psychiatric hospital stay | 15% after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://d2ed110nmrd591.cloudfront.net/blobs/KKB4gcMBAApbbkv5Xzdmpn9X.pdf |
