UHC Silver-C Advantage (Virtual Urgent Care + PCP Visits, Rx Copay) – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $10 copay
Urgent care visit: $50 copay
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $150 per person $150 per person |
| Out-of-pocket max | $1,400 per person $2,800 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $10 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $50 copay |
| Emergency room | $400 copay after deductible |
| Ambulance | 5% coinsurance after deductible |
| Hospital stay (facility) | 5% coinsurance after deductible |
| Hospital stay (physician) | 5% coinsurance after deductible |
| Outpatient procedure (facility) | $15 copay after deductible |
| Outpatient procedure (physician) | $15 copay after deductible |
| Physical rehabilitation | $10 copay after deductible |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 5% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $1 copay |
| Brand | $30 copay |
| Non-preferred Brand | $75 copay |
| Specialty | $200 copay |
Lab Tests and Diagnostic Procedures
| X-rays | $5 copay after deductible |
| Imaging (CT/PET/MRI) | $10 copay after deductible |
| Blood work | $1 copay after deductible |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $10 copay after deductible |
| Psychiatric hospital stay | 5% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.uhc.com/ifp/sbc.42529IL0070025-06.en.2024 |
| Drug and medication plan formulary | https://www.uhc.com/xildruglist2024 |
| Search doctor list | https://www.uhc.com/xildocfindg2024 |
