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
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 |