U Health Plus Silver – EPO
94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $30 copay
Urgent care visit: No charge
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $1,600 per person $3,200 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $30 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | No charge |
| Emergency room | $100 copay |
| Ambulance | $250 copay |
| Hospital stay (facility) | 10% coinsurance |
| Hospital stay (physician) | 10% coinsurance |
| Outpatient procedure (facility) | 10% coinsurance |
| Outpatient procedure (physician) | 10% coinsurance |
| Physical rehabilitation | 10% coinsurance |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 10% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $25 copay |
| Non-preferred Brand | 50% coinsurance |
| Specialty | 50% coinsurance |
Lab Tests and Diagnostic Procedures
| X-rays | 10% coinsurance |
| Imaging (CT/PET/MRI) | 10% coinsurance |
| Blood work | 10% coinsurance |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 10% coinsurance |
| Psychiatric hospital stay | 10% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://doc.uhealthplan.utah.edu/individual/2024/sbc/uhealthplus/silvercsr94.pdf |
| Drug and medication plan formulary | https://cbg.adaptiverx.com/webSearch/index?key=8F02B26A288102C27BAC82D14C006C6FC54D480F80409B6872F239C8ABCF9F40 |
| Search doctor list | https://uuhip.healthtrioconnect.com/public-app/consumer/provdir/entry.page?xsesschk= |
