Silver ST by Univera Healthcare
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Silver ST
- Insurance Company
- Univera Healthcare
In Network Benefits
- Office Co-pay
- $30 after deductible (first visit is NSD)
- Specialist Co-pay
- $65 after deductible (first visit is NSD)
- Hospital Co-pay
- $1,500 after deductible
- Emergency Room
- $500 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $15/$40/$75
- In-Network Deductible (single/family)
- $2,100 / $4,200
- In-Network Co-Insurance
- N/A
- Max Out of Pocket (single/family)
- $9,450 / $18,900
Out Of Network Benefits
- Deductible (single/family)
- N/A
- Co-Insurance
- N/A
- Deductible
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental
- Renewal Date
- 12/31/2024
- HSA Eligible
- No
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