SimpliveraCoverage Companion

HMO Silver 7000

Aspirus Health Plan, Inc. · 2027 plan year

Silver
Ind. deductible
$500
Family deductible
$1,000
Ind. OOP max
$2,200
Family OOP max
$4,400

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan87% AV Level Silver PlanLimited Cost Sharing Plan VariationStandard Silver On Exchange PlanZero Cost Sharing Plan Variation

More Aspirus Health Plan, Inc. plans in MN

HMO Gold 2000HMO Silver 6600Aspirus Health Plan Easy Compare Bronze AutographAspirus Health Plan Easy Compare Silver and Rx Copay AutographAspirus Health Plan Easy Compare Gold and Rx Copay Autograph

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or IllnessNo charge

Specialist

BenefitIn-network
Specialist Visit$10.00

Hospital

BenefitIn-network
Emergency Room Services25.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)25.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services25.00% Coinsurance after deductible
Urgent Care Centers or Facilities$5.00

Pharmacy

BenefitIn-network
Generic DrugsNo charge
Non-Preferred Brand Drugs$50.00
Preferred Brand Drugs$15.00
Specialty Drugs$150.00

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services25.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient ServicesNo charge

Other

BenefitIn-network
Abortion for Which Public Funding is Prohibited25.00% Coinsurance after deductible
Accidental Dental25.00% Coinsurance after deductible
Allergy Testing25.00% Coinsurance after deductible
Chemotherapy25.00% Coinsurance after deductible
Chiropractic CareNo charge
Delivery and All Inpatient Services for Maternity Care25.00% Coinsurance after deductible
Diabetes Education25.00% Coinsurance after deductible
Dialysis25.00% Coinsurance after deductible
Durable Medical Equipment25.00% Coinsurance after deductible
Emergency Transportation/Ambulance25.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation ServicesNo charge
Hearing Aids25.00% Coinsurance after deductible
Home Health Care Services25.00% Coinsurance after deductible
Hospice Services25.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)25.00% Coinsurance after deductible
Infusion Therapy25.00% Coinsurance after deductible
Inpatient Physician and Surgical Services25.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services25.00% Coinsurance after deductible
Nutritional CounselingNo charge
Other Practitioner Office Visit (Nurse, Physician Assistant)No charge
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)25.00% Coinsurance after deductible
Outpatient Rehabilitation Services25.00% Coinsurance after deductible
Prenatal and Postnatal Care25.00% Coinsurance after deductible
Prosthetic Devices25.00% Coinsurance after deductible
Radiation25.00% Coinsurance after deductible
Reconstructive Surgery25.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical TherapyNo charge
Rehabilitative Speech TherapyNo charge
Routine Eye Exam for ChildrenNo charge
Skilled Nursing Facility25.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services25.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient ServicesNo charge
Transplant25.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders25.00% Coinsurance after deductible
Virtual Care$20.00
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible

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