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Cox HealthPlans

Cox HealthPlans | Cox HealthPlans Silver 4000 PPO Network

  • Cox HealthPlans Silver 4000 PPO Network is an Obamacare health insurance plan offered by Cox HealthPlans that is available for individuals and families.

  • This plan is a PPO, meaning you will have the flexibility to visit a preferred healthcare provider network that have preferred rates for in-network physicians. (Read more about PPOs.)

  • This plan is a Silver metal level plan, which generally has a mid-level monthly cost and deductible (and co-pay), and provides middle-of-the-road insurance coverage for people who occasionally use their health care benefits (doctors, prescription drugs, etc.).

  • Deductible amount of $4,000. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of $6,000, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.

Ways to Enroll or Learn More

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Plan Summary

Monthly Cost
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Plan Name:
Cox HealthPlans Silver 4000 PPO Network
Plan ID:
96384MO0140021
Plan Type:
PPO
Deductible:
$4,000
Maximum Out-of-Pocket:
$6,000
Summary of Benefits:
View Summary
Provider Information:
View Information

Who is this plan for?

This plan with a moderate monthly cost is great for individuals and families who occasionally visit the doctor or use prescription drugs. The very high deductible on this plan means you will pay a significant amount of money of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. Plans with this type of provider network tend to have a more broad provider network.
HealthCare.com is a privately-held website for healthcare consumers operating since 2007. We’re not the government marketplace.

Highlights

Dental Coverage:
Child
Emergency Room:
$450
Retail Drugs:
$45
Generic Drugs:
$15

Overview

Plan Type:
PPO
Metal Level:
Silver
Health Spending Account:
No
Primary Care Office Visit:
1st 3 Visits $10 copay; subsequent visits 20% coinsurance after deductible
Specialist Office Visit:
20% coinsurance after deductible
Out of Network Coverage:
Yes
Out of Country Coverage:
Yes

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge
Out of Network:
50% coinsurance after deductible U&C
Well Baby Care
In Network:
No Charge
Out of Network:
50% coinsurance after deductible U&C

Inpatient

Hospital Services
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Physician Fee
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Skilled Nursing Facility
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Mental Health
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Substance Abuse
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Home Healthcare
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C

Outpatient

X-ray and Diagnostics
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Labs
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Facility Fee
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Mental Health
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Substance Abuse
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Labor and Delivery Inpatient Services
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C

Dental

Accidental Care
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Basic Dental Care (Child)
In Network:
20% coinsurance after deductible
Out of Network:
20% coinsurance after deductible
Dental Checkup (Child)
In Network:
20% coinsurance after deductible
Out of Network:
20% coinsurance after deductible
Major Dental Care (Child)
In Network:
20% coinsurance after deductible
Out of Network:
20% coinsurance after deductible
Orthodontia (Child)
In Network:
20% coinsurance after deductible
Out of Network:
20% coinsurance after deductible

Vision

Eye Exam (Child)
In Network:
20% coinsurance after deductible
Out of Network:
20% coinsurance after deductible
Glasses (Child)
In Network:
20% coinsurance after deductible
Out of Network:
20% coinsurance after deductible

Additional Coverage

Chiropractic Care
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Rehabilitation Services (Speech)
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Rehabilitation Services (Occupational Therapy)
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Hospice Service
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Durable Medical Equipment
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C

Doctor Visits

Primary Care Visit
In Network:
1st 3 Visits $10 copay; subsequent visits 20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Specialist Visit
In Network:
20% coinsurance after deductible
Out of Network:
50% coinsurance after deductible U&C
Preventative Care / Screening / Immunization
In Network:
No Charge
Out of Network:
50% coinsurance after deductible U&C

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$450
Out of Network:
$450
Urgent Care Services
In Network:
$75
Out of Network:
50% coinsurance after deductible U&C
Ambulance/Transportation Services
In Network:
20% coinsurance after deductible
Out of Network:
20% coinsurance after deductible

Drugs

Generic Prescription
In Network:
$15
Out of Network:
50% coinsurance after deductible U&C
Retail Brand Drugs
In Network:
$45
Out of Network:
50% coinsurance after deductible U&C
Non Retail Brand Drugs
In Network:
$75
Out of Network:
50% coinsurance after deductible U&C
Specialty Drugs
In Network:
$100
Out of Network:
Not Applicable

Additional Plan Information

Summary Of Benefits:
View Summary
Provider Information:
View Information
Talk to a Licensed Agent
(877) 626-1943GET PRICE

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

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