Silver Plans

Cost-Sharing and Lower Premium

The benefit levels of our HMO Silver Plan are the same as our HMO Gold plans, but with greater cost-sharing for your employees.
 
This means lower premiums and greater overall savings; plus, this plan allows your employees to take advantage of the wide variety of local providers and services included in the FirstCare network.

Call us today to learn more about enrollment timeframes and to find a plan that fits your needs. 1-855-572-7238.

Glance through the chart below for a comparison, or open up the linked PDFs for more details.

 2018 Silver Plans

2017 Plan Benefits Select Network	HMO Silver Coinsurance 3100	HMO Silver Coinsurance 4500	HMO Silver Copay	HMO Silver HSA (100%)
Medical Deductible (if any) Single/Family	$3,100/$6,200	$4,500/$9,000	$3,700/$7,400	$3,750/$7,500
Medication Deductible (if any)  Single/Family	$0/$0	$0/$0	$0/$0	Integrated with Medical
Preventive Care Copay	No Charge	No Charge	No Charge	No Charge
Adult Primary Care Visit Copay	$25	$25	$25	0%1
Pediatric Primary Care Visit Copay (Ages 0-19)	No Charge	No Charge	No Charge	0%1
Specialty Care Visit Copay	$50	$50	$50	0%1
Inpatient Copay	20%1	20%1	$600 copay per day1, not to exceed $3,000 per stay	0%1
Outpatient Copay	20%1	20%1	$600 copay1	0%1
Emergency Room Copay	$5001	$5001	$5001	0%1
Urgent Care Copay	$50	$50	$50	0%1
Routine Lab/X-Ray Copay	No Charge	No Charge	No Charge	0%1
Imaging (MRI, CT, Scans) Copay	$250 per test1	$250 per test1	$250 per test1	0%1
Medication Copays: Tier I Tier II Tier III Tier IV Tier V	$0 $20 $50 $100 40%	$0 $10 $50 $100 40%	$0 $20 $50 $100 40%	0%1 0%1 0%1 0%1 0%1
Maximum Out-Of-Pocket Single/Family	$7,150/$14,300	$6,000/$12,000	$6,850/$13,700	$3,750/$7,500
Plan ID	26539TX0130003- 00	26539TX0130017- 00	26539TX0130006- 00	26539TX0130016- 00
Summary of Benefits & Coverage (SBC)
Plan Documents

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2017 Plan Benefits Select Plus Network	HMO Silver Coinsurance 3100	HMO Silver Coinsurance 4500	HMO Silver Copay	HMO Silver HSA (100%)
Medical Deductible (if any) Single/Family	$3,100/$6,200	$4,500/$9,000	$3,700/$7,400	$3,750/$7,500
Medication Deductible (if any)  Single/Family	$0/$0	$0/$0	$0/$0	Integrated with Medical
Preventive Care Copay	No Charge	No Charge	No Charge	No Charge
Adult Primary Care Visit Copay	$25	$25	$25	0%1
Pediatric Primary Care Visit Copay (Ages 0-19)	No Charge	No Charge	No Charge	0%1
Specialty Care Visit Copay	$50	$50	$50	0%1
Inpatient Copay	20%1	20%1	$600 copay per day1, not to exceed $3,000 per stay	0%1
Outpatient Copay	20%1	20%1	$600 copay1	0%1
Emergency Room Copay	$5001	$5001	$5001	0%1
Urgent Care Copay	$50	$50	$50	0%1
Routine Lab/X-Ray Copay	No Charge	No Charge	No Charge	0%1
Imaging (MRI, CT, Scans) Copay	$250 per test1	$250 per test1	$250 per test1	0%1
Medication Copays: Tier I Tier II Tier III Tier IV Tier V	$0 $20 $50 $100 40%	$0 $10 $50 $100 40%	$0 $20 $50 $100 40%	0%1 0%1 0%1 0%1 0%1
Maximum Out-Of-Pocket Single/Family	$7,150/$14,300	$6,000/$12,000	$6,850/$13,700	$3,750/$7,500
Plan ID	26539TX0130010- 00	26539TX0130019- 00	26539TX0130011- 00	26539TX0130015- 00
Summary of Benefits & Coverage (SBC)
Plan Documents