UHC Silver-D Value ($0 Virtual Urgent Care + $0 PCP Visits, $2 Tier 2 Rx, $0 Insulin) – HMO

Description

This plan has 87% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$600 per person $600 per person
Out-of-pocket max	$2,800 per person $5,600 per family
Metal tier	Silver

Visit Copay

Primary care visit	No charge
Specialist visit	35% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$50 copay
Emergency room	35% coinsurance after deductible
Ambulance	35% coinsurance after deductible
Hospital stay (facility)	35% coinsurance after deductible
Hospital stay (physician)	35% coinsurance after deductible
Outpatient procedure (facility)	35% coinsurance after deductible
Outpatient procedure (physician)	35% coinsurance after deductible
Physical rehabilitation	35% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	35% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$2 copay
Brand	$45 copay after deductible
Non-preferred Brand	40% coinsurance after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	35% coinsurance after deductible
Imaging (CT/PET/MRI)	35% coinsurance after deductible
Blood work	$10 copay

Mental and Psychiatric Health Care

Mental Health outpatient services	35% coinsurance after deductible
Psychiatric hospital stay	35% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.uhc.com/ifp/sbc.40220TX0080025-05.en.2024
Drug and medication plan formulary	https://www.uhc.com/xtxdruglist2024
Search doctor list	https://www.uhc.com/xtxdocfindg2024