QUARTZ SELECT SILVER (VISION) $0 DED FLAT RX COPAYS CSR 94
Quartz Health Plan MN Corporation · 2027 plan year
Silver
- Ind. deductible
- No deductible
- Family deductible
- $0
- Ind. OOP max
- $2,500
- Family OOP max
- $5,000
Other cost-sharing reduction variants for this plan:
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Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $10.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $20.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $125.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | $125.00 Copay per Day |
| Outpatient Surgery Physician/Surgical Services | 50.00% |
| Urgent Care Centers or Facilities | $20.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | No charge |
| Non-Preferred Brand Drugs | $100.00 |
| Preferred Brand Drugs | $25.00 |
| Specialty Drugs | $200.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $125.00 Copay per Day |
| Mental/Behavioral Health Outpatient Services | $10.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | 50.00% |
| Accidental Dental | 50.00% |
| Acupuncture | 50.00% |
| Allergy Testing | 50.00% |
| Chemotherapy | 50.00% |
| Chiropractic Care | $10.00 |
| Clinical Trials | 50.00% |
| Delivery and All Inpatient Services for Maternity Care | $125.00 |
| Diabetes Education | 50.00% |
| Dialysis | 50.00% |
| Durable Medical Equipment | 50.00% |
| Emergency Transportation/Ambulance | 50.00% |
| Eye Glasses for Children | 50.00% |
| Gender Affirming Care | 50.00% |
| Habilitation Services | $10.00 |
| Hearing Aids | 50.00% |
| Home Health Care Services | 50.00% |
| Hospice Services | 50.00% |
| Imaging (CT/PET Scans, MRIs) | $125.00 |
| Infusion Therapy | 50.00% |
| Inpatient Physician and Surgical Services | 50.00% |
| Laboratory Outpatient and Professional Services | $20.00 |
| Nutritional Counseling | $10.00 |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $10.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $125.00 |
| Outpatient Rehabilitation Services | $10.00 |
| PANDAS/PANS | 50.00% |
| Prenatal and Postnatal Care | No charge |
| Prosthetic Devices | 50.00% |
| Radiation | 50.00% |
| Reconstructive Surgery | 50.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $10.00 |
| Rehabilitative Speech Therapy | $10.00 |
| Routine Eye Exam (Adult) | $10.00 |
| Routine Eye Exam for Children | $10.00 |
| Routine Foot Care | 50.00% |
| Skilled Nursing Facility | $125.00 Copay per Day |
| Substance Abuse Disorder Inpatient Services | $125.00 Copay per Day |
| Substance Abuse Disorder Outpatient Services | $10.00 |
| Transplant | 50.00% |
| Treatment for Temporomandibular Joint Disorders | 50.00% |
| Virtual Visit | No charge |
| Well Baby Visits and Care | No charge |
| Wigs | 50.00% |
| X-rays and Diagnostic Imaging | $20.00 |
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