UHC Silver Value C On Exchange – HMO

94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: $5 copay
Specialist visit: $15 copay
Urgent care visit: $10 copay

SKU: 65428NM002000106 Category:

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type HMO
Deductible $0 per person $0 per person
Out-of-pocket max $1,500 per person $3,000 per family
Metal tier Silver

Visit Copay

Primary care visit $5 copay
Specialist visit $15 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $10 copay
Emergency room 30% coinsurance
Ambulance 15% coinsurance
Hospital stay (facility) 15% coinsurance
Hospital stay (physician) 15% coinsurance
Outpatient procedure (facility) 15% coinsurance
Outpatient procedure (physician) 15% coinsurance
Physical rehabilitation $5 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay 15% coinsurance

Pharmacy, Drugs, and Medication

Generic $1 copay
Brand $20 copay
Non-preferred Brand 30% coinsurance
Specialty 40% coinsurance

Lab Tests and Diagnostic Procedures

X-rays 15% coinsurance
Imaging (CT/PET/MRI) 15% coinsurance
Blood work $3 copay

Mental and Psychiatric Health Care

Mental Health outpatient services No charge
Psychiatric hospital stay No charge

Health Plan Provider Information

Drug and medication plan formulary https://www.uhc.com/xnmdruglist2024
Search doctor list https://www.uhc.com/xnmdocfindoa2024