WellSense Clarity ConnectorCare 3 – HMO
73% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: $22 copay
Urgent care visit: $22 copay
Description
This plan has 73% 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 | No charge |
| Specialist visit | $22 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $22 copay |
| Emergency room | $100 copay |
| Ambulance | No charge |
| Hospital stay (facility) | $250 copay |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | $125 copay |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | $20 copay |
Maternitowny and Pregnancy
| Labor, delivery, hospital stay | $250 copay |
Pharmacy, Drugs, and Medication
| Generic | $12.50 copay |
| Brand | $25 copay |
| Non-preferred Brand | $50 copay |
| Specialty | $50 copay |
Lab Tests and Diagnostic Procedures
| X-rays | No charge |
| Imaging (CT/PET/MRI) | $60 copay |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | No charge |
| Psychiatric hospital stay | $250 copay |
