Coventry Silver $10 Copay PPO Carelink from Coventry MO

Plan Information
Company Coventry Health Care
State MO
Metal Tier Silver
Plan Type PPO

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) $3,750 Data Not Available
Deductible (Family) $7,500 Data Not Available
Coinsurance Data Not Available 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 $10 Data Not Available
Specialist Visit $75 Data Not Available
In Patient Hospital Services $500 Copay per Stay and 30% Coin Data Not Available
Emergency Room Services $500 Data Not Available
Mental / Behavioral Health Data Not Available Data Not Available
Imaging (CT/PET Scans, MRIs) Data Not Available Data Not Available
Rehabilitative Speech Therapy Data Not Available Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available Data Not Available
Preventative Care Data Not Available Data Not Available
Laboratory Outpatient and Professional Services Data Not Available Data Not Available
X-ray and Diagnostic Imaging Data Not Available Data Not Available
Outpatient Facility Data Not Available Data Not Available
Outpatient Surgery Data Not Available Data Not Available
Prescription Drugs In Network Out of Network
Generic Rx $15
Preferred Brand Rx $45 Copay after deductible
Non Preferred Brand Rx $75 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

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) $3,750.00
Deductible (Family) $7,500.00
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 $10
Specialists $75
Emergency Room $500
Inpatient Facility $500 Copay per Stay and 30% Coin
Inpatient Physician 30% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $15.00
Preferred Brand Rx $45 Copay after deductible
Non Preferred Brand Rx $75 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

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) $1,750.00
Deductible (Family) $3,500.00
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 $10
Specialists $50
Emergency Room $100
Inpatient Facility No Charge after deductible
Inpatient Physician No Charge after Deductible
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $35
Non Preferred Brand Rx $75
Specialty Drugs 30%

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) $1,500.0
Out of Pocket Maximum (Family) $3,000.00
Services In Network Out of Network
Primary Care Physician No Charge
Specialists $25
Emergency Room $100
Inpatient Facility 10%
Inpatient Physician 10%
Prescription Drugs In Network Out of Network
Generic Rx $5.00
Preferred Brand Rx $30
Non Preferred Brand Rx $55
Specialty Drugs 20%

Other Plans

Other plans that are available in the state.

Plan Name
Coventry Gold $5 Copay PPO
Coventry Silver $10 Copay PPO
Coventry Bronze $20 Copay PPO
Coventry Bronze Deductible Only HSA Eligible PPO
Coventry Silver $5 Copay 2750 PPO
Coventry Gold $5 Copay KCPPO
Coventry Silver $10 Copay KCPPO
Coventry Bronze $20 Copay KCPPO
Coventry Bronze Deductible Only HSA Eligible KCPPO
Coventry Silver $5 Copay 2750 KCPPO
Coventry Silver HSA Eligible KCPPO
Coventry Silver HSA Eligible PPO
Coventry Gold $10 Copay
Coventry Silver $15 Copay
Coventry Bronze $25 Copay
Coventry Bronze Deductible Only HSA Eligible
Coventry Silver $10 Copay 2750
Coventry Gold $5 Copay Carelink
Coventry Silver $10 Copay Carelink
Coventry Bronze $20 Copay Carelink
Coventry Bronze Deductible Only HSA Eligible Carelink
Coventry Bronze $25 Copay FocusedCare HPN
Coventry Bronze Deductible Only HSA Eligible FocusedCare HPN
Coventry Gold $10 Copay FocusedCare HPN
Coventry Silver $10 Copay 2750 FocusedCare HPN
Coventry Silver $15 Copay FocusedCare HPN
Coventry Silver $5 Copay 2750 Carelink
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