Meritus Meritus Community Network - Phoenix AZ

Plan Information
Company Meritus Health Partners
State AZ
Metal Tier Silver
Plan Type HMO

Cost Sharing Benefits

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $5,000 Data Not Available
Deductible (Family) $10,000 Data Not Available
Coinsurance $0 Data Not Available
Out of Pocket Maximum (Individual) $6,350 Data Not Available
Out of Pocket Maximum (Family) $12,700 Data Not Available
Services In Network Out of Network
Primary Care Visit No Charge Data Not Available
Specialist Visit $100 Data Not Available
In Patient Hospital Services $1000 Copay per Stay Data Not Available
Emergency Room Services $500 $500 copay
Mental / Behavioral Health Data Not Available Data Not Available
Imaging (CT/PET Scans, MRIs) $300 copay Data Not Available
Rehabilitative Speech Therapy Data Not Available Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available Data Not Available
Preventative Care $0 Data Not Available
Laboratory Outpatient and Professional Services $100 copay Data Not Available
X-ray and Diagnostic Imaging $100 copay Data Not Available
Outpatient Facility $400 copay Data Not Available
Outpatient Surgery $400 copay Data Not Available
Prescription Drugs In Network Out of Network
Generic Rx $20
Preferred Brand Rx $72
Non Preferred Brand Rx $150
Specialty Drugs 40%

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $2,200.00
Deductible (Family) $4,400.00
Out of Pocket Maximum (Individual) $5,200.00
Out of Pocket Maximum (Family) $10,400.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists $75
Emergency Room $500
Inpatient Facility $1000 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $15.00
Preferred Brand Rx $65
Non Preferred Brand Rx $150
Specialty Drugs 40%

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $0.00
Deductible (Family) $0.00
Out of Pocket Maximum (Individual) $2,250.00
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists $50
Emergency Room $250
Inpatient Facility $500 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $35
Non Preferred Brand Rx $85
Specialty Drugs 40%

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $0.00
Deductible (Family) $0.00
Out of Pocket Maximum (Individual) $2,250.0
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists $15
Emergency Room $85
Inpatient Facility $150 Copay per Stay
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $5.00
Preferred Brand Rx $10
Non Preferred Brand Rx $35
Specialty Drugs 40%

Other Plans

Other plans that are available in the state.

Plan Name
Meritus Neighborhood Network Silver HMO MIHS
Meritus Community Network Silver HMO Banner
Meritus Community Network Silver HMO Pima
Meritus Healthy Bronze Complete HMO 6000
Meritus Healthy Bronze HMO Banner 6000
Meritus Healthy Bronze HMO Abrazo 6000
Meritus Healthy Bronze HMO Pima 6000
Meritus Healthy Bronze HMO Mohave 6000
Meritus Healthy Silver Complete HMO 4000
Meritus Healthy Silver HMO Banner 4000
Meritus Healthy Silver HMO Abrazo 4000
Meritus Healthy Silver HMO Pima 4000
Meritus Healthy Silver HMO MIHS 4000
Meritus Healthy Silver HMO Mohave 4000
Meritus Healthy Gold Complete HMO Plus 2000
Meritus Healthy Gold HMO Plus Banner 2000
Meritus Healthy Gold HMO Plus Abrazo 2000
Meritus Healthy Gold HMO Plus Pima 2000
Meritus Healthy Gold HMO Plus Mohave 2000
Meritus Healthy Platinum Complete HMO Plus 500
Meritus Healthy Platinum HMO Plus Banner 500
Meritus Healthy Platinum HMO Plus Abrazo 500
Meritus Healthy Platinum HMO Plus Pima 500
Meritus Healthy Platinum HMO Plus Mohave 500
Meritus Choice Bronze PPO Plus 6000
Meritus Choice Silver PPO Plus 4000
Meritus Choice Gold PPO Plus 2000
Meritus Saver Bronze PPO HSA Plus 6300
Meritus Saver Silver PPO HSA Plus 2000
Meritus Saver Gold PPO HSA Plus 1500
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