WellFirst by Medica Silver Standard 0X (Free Virtual Visits) – EPO

94% cost sharing reduction [Popular Plan]
Network type: EPO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $10 copay
Urgent care visit: $5 copay

SKU: 47840MO001001606 Category:

Description

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

Health Care Plan Details

Network type EPO
Deductible $0 per person $0 per person
Out-of-pocket max $1,800 per person $3,600 per family
Metal tier Silver

Visit Copay

Primary care visit No charge
Specialist visit $10 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $5 copay
Emergency room 25% coinsurance
Ambulance 25% coinsurance
Hospital stay (facility) 25% coinsurance
Hospital stay (physician) 25% coinsurance
Outpatient procedure (facility) 25% coinsurance
Outpatient procedure (physician) 25% coinsurance
Physical rehabilitation No charge

Maternitowny and Pregnancy

Well baby care No data available
Labor, delivery, hospital stay 25% coinsurance

Pharmacy, Drugs, and Medication

Generic No charge
Brand $15 copay
Non-preferred Brand $50 copay
Specialty $150 copay

Lab Tests and Diagnostic Procedures

X-rays 25% coinsurance
Imaging (CT/PET/MRI) 25% coinsurance
Blood work 25% coinsurance

Mental and Psychiatric Health Care

Mental Health outpatient services No charge
Psychiatric hospital stay 25% coinsurance

Health Plan Provider Information

Health Plan Benefits https://sbc.mo-central.medica.com/api/GetPdfFile/true/WellFirst-MO-by-Medica-Silver-Standard-0X06_0124.PDF
Drug and medication plan formulary https://www.Medica.com/WellFirstMODrugList-2024
Search doctor list https://www.Medica.com/SearchWellFirstMONetwork-2024