SoloCare Platinum No Referral HMO – $0 PCP, $0 Generic Rx – HMO
Network type: HMO
Coverage tier: Platinum
Primary care visit: No charge
Specialist visit: 20% coinsurance after deductible
Urgent care visit: 20% coinsurance after deductible
Description
Health Care Plan Details
Network type | HMO |
Deductible | $750 per person $750 per person |
Out-of-pocket max | $1,500 per person $3,000 per family |
Metal tier | Platinum |
Visit Copay
Primary care visit | No charge |
Specialist visit | 20% coinsurance after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | 20% coinsurance after deductible |
Emergency room | 20% coinsurance after deductible |
Ambulance | 20% coinsurance after deductible |
Hospital stay (facility) | 20% coinsurance after deductible |
Hospital stay (physician) | 20% coinsurance after deductible |
Outpatient procedure (facility) | 20% coinsurance after deductible |
Outpatient procedure (physician) | 20% coinsurance after deductible |
Physical rehabilitation | 20% coinsurance after deductible |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | 20% coinsurance after deductible |
Pharmacy, Drugs, and Medication
Generic | Share |
Brand | 20% coinsurance after deductible |
Non-preferred Brand | 20% coinsurance after deductible |
Specialty | 20% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 20% coinsurance after deductible |
Imaging (CT/PET/MRI) | 20% coinsurance after deductible |
Blood work | No charge |
Mental and Psychiatric Health Care
Mental Health outpatient services | No charge |
Psychiatric hospital stay | 20% coinsurance after deductible |
Health Plan Provider Information
Health Plan Benefits | https://alliantplans.com/doc/2024/solocare/110028-01.pdf |
Drug and medication plan formulary | https://magellan.adaptiverx.com/webSearch/index?key=cnhmbGV4LnBsYW4uUGxhblBkZlR5cGUtOTE3 |
Search doctor list | https://idirectory.alliantplans.com/ProviderSearch |