UHC Silver Copay Focus – EPO
Network type: EPO
Coverage tier: Silver
Primary care visit: $20 copay
Specialist visit: $50 copay
Urgent care visit: $75 copay
Description
Health Care Plan Details
| Network type | EPO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $7,850 per person $15,700 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | $20 copay |
| Specialist visit | $50 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $75 copay |
| Emergency room | $1500 copay |
| Ambulance | 30% coinsurance |
| Hospital stay (facility) | $2500 copay per Day |
| Hospital stay (physician) | 30% coinsurance |
| Outpatient procedure (facility) | $750 copay |
| Outpatient procedure (physician) | $750 copay |
| Physical rehabilitation | $50 copay |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $2500 copay |
Pharmacy, Drugs, and Medication
| Generic | $30 copay |
| Brand | $85 copay after deductible |
| Non-preferred Brand | 50% coinsurance after deductible |
| Specialty | 50% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
| X-rays | $65 copay |
| Imaging (CT/PET/MRI) | $275 copay |
| Blood work | $20 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | $50 copay |
| Psychiatric hospital stay | $2500 copay per Day |
Health Plan Provider Information
| Health Plan Benefits | https://www.uhc.com/ifp/sbc.62650WA0020017-01.en.2024 |
| Drug and medication plan formulary | https://www.uhc.com/xwadruglist2024 |
| Search doctor list | https://www.uhc.com/xwadocfindg2024 |
