Hometown Health - IFP Renown Silver 70 HMO_87
Primary Care Visit
0% Coinsurance after deductible
100% Coinsurance
Specialist Visit
0% Coinsurance after deductible
100% Coinsurance
Other Practitioner Office Visit (Nurse, Physician Assistant)
0% Coinsurance after deductible
100% Coinsurance
Preventive Care/Screening/Immunization
No Charge
100% Coinsurance
Laboratory Outpatient and Professional Services
0% Coinsurance after deductible
100% Coinsurance
X-rays and Diagnostic Imaging
0% Coinsurance after deductible
100% Coinsurance
Imaging (CT/PET scans, MRIs)
0% Coinsurance after deductible
100% Coinsurance
Generic Drugs
$0 Copay after deductible
100% Coinsurance
Preferred Brand Drugs
$0 Copay after deductible
100% Coinsurance
Non-Preferred Brand Drugs
$0 Copay after deductible
100% Coinsurance
Specialty drugs
$0 Copay after deductible
100% Coinsurance
Outpatient Facility Fee
0% Coinsurance after deductible
100% Coinsurance
Outpatient Surgery Physician/Surgical Services
0% Coinsurance after deductible
100% Coinsurance
Emergency Room Services
0% Coinsurance after deductible
0% Coinsurance after deductible
Emergency Transportation/Ambulance
0% Coinsurance after deductible
Not Applicable
Urgent Care
$50 Copay
100% Coinsurance
Inpatient Hospital Services
0% Coinsurance after deductible
100% Coinsurance
Inpatient Physician and Surgical Services
0% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Outpatient Services
0% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Inpatient Services
0% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Outpatient Services
0% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Inpatient Services
0% Coinsurance after deductible
100% Coinsurance
Prenatal and postnatal care
No Charge
100% Coinsurance
Delivery and All Inpatient Services for Maternity Care
0% Coinsurance after deductible
100% Coinsurance
Home Healthcare Services
0% Coinsurance after deductible
100% Coinsurance
Outpatient Rehabilitation Services
0% Coinsurance after deductible
100% Coinsurance
Habilitation Services
0% Coinsurance after deductible
100% Coinsurance
Skilled Nursing Facility
0% Coinsurance after deductible
100% Coinsurance
Durable Medical Equipment
0% Coinsurance after deductible
100% Coinsurance
Hospice Services
0% Coinsurance after deductible
100% Coinsurance
Chiropractic Care
0% Coinsurance after deductible
100% Coinsurance
Acupuncture
Not Covered
Not Covered
Rehabilitative Speech Therapy
0% Coinsurance after deductible
100% Coinsurance
Rehabilitative Occupational and Rehabilitative Physical Therapy
0% Coinsurance after deductible
100% Coinsurance
Well Baby Visits and Care
No Charge
100% Coinsurance
Allergy Testing
0% Coinsurance after deductible
100% Coinsurance
Diabetes Education
0% Coinsurance after deductible
100% Coinsurance
Nutritional Counseling
0% Coinsurance after deductible
100% Coinsurance
Eye Exam for Children
No Charge
100% Coinsurance
Eye Glasses for Children
No Charge
100% Coinsurance
Accidental Dental
0% Coinsurance after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not Covered
Not Covered
Basic Dental Care (Child)
Not Covered
Not Covered
Dental Check Up (Child)
Not Covered
Not Covered
Major Dental Care (Adult)
Not Covered
Not Covered
Major Dental Care (Child)
Not Covered
Not Covered
Orthodontia (Adult)
Not Covered
Not Covered
Orthodontia (Child)
Not Covered
Not Covered
Routine Dental Services (Adult)
Not Covered
Not Covered