UHC Silver Copay Focus – HMO

Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $100 copay
Urgent care visit: $75 copay

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Description

Health Care Plan Details

Network type HMO
Deductible $0 per person $0 per person
Out-of-pocket max $9,450 per person $18,900 per family
Metal tier Silver

Visit Copay

Primary care visit No charge
Specialist visit $100 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 $100 copay

Maternitowny and Pregnancy

Labor, delivery, hospital stay $2500 copay

Pharmacy, Drugs, and Medication

Generic $10 copay
Brand $85 copay after deductible
Non-preferred Brand 40% coinsurance after deductible
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays $65 copay
Imaging (CT/PET/MRI) $300 copay
Blood work $20 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $95 copay
Psychiatric hospital stay $2500 copay per Day

Health Plan Provider Information

Health Plan Benefits https://d2ed110nmrd591.cloudfront.net/blobs/1CM44ijaKM7REYUKnZhbfbgH.pdf
Drug and medication plan formulary https://www.uhc.com/xvadruglist2024
Search doctor list https://www.uhc.com/xvadocfindoa2024