Medica - Medica Applause Silver Copay ($0 Virtual Care + Online Wellness)
Yearly Deductible
Out-of-Pocket Maximum
Primary Care Visit
$40 Copay
100% Coinsurance
Specialist Visit
$90 Copay
100% Coinsurance
Other Practitioner Office Visit
$40 Copay
100% Coinsurance
Preventive Care/Screening/Immunization
No Charge
100% Coinsurance
X-rays and Diagnostic Imaging
40% Coinsurance after deductible
100% Coinsurance
Imaging (CT/PET scans, MRIs)
40% Coinsurance after deductible
100% Coinsurance
Generic Drugs
$10 Copay
100% Coinsurance
Preferred Brand Drugs
$120 Copay
100% Coinsurance
Non-Preferred Brand Drugs
60% Coinsurance after deductible
100% Coinsurance
Specialty Drugs
$700 Copay
100% Coinsurance
Outpatient Services
40% Coinsurance after deductible
100% Coinsurance
Emergency Room
40% Coinsurance after deductible
40% Coinsurance after deductible
Ambulance Services
40% Coinsurance after deductible
40% Coinsurance after deductible
Urgent Care Services
$40 Copay
$40 Copay
Inpatient Hospital Services
40% Coinsurance after deductible
100% Coinsurance
Inpatient Physician and Surgical Services
40% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Outpatient Services
$40 Copay
100% Coinsurance
Mental/Behavioral Health Inpatient Services
40% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Outpatient Services
$40 Copay
100% Coinsurance
Substance Abuse Disorder Inpatient Services
40% Coinsurance after deductible
100% Coinsurance
Prenatal and Postnatal Care
40% Coinsurance after deductible
100% Coinsurance
Delivery and All Inpatient Services for Maternity Care
40% Coinsurance after deductible
100% Coinsurance
Home Healthcare Services
40% Coinsurance after deductible
100% Coinsurance
Outpatient Rehabilitation Services
40% Coinsurance after deductible
100% Coinsurance
Habilitation Services
40% Coinsurance after deductible
100% Coinsurance
Skilled Nursing Facility
40% Coinsurance after deductible
100% Coinsurance
Durable Medical Equipment
40% Coinsurance after deductible
100% Coinsurance
Hospice Services
40% Coinsurance after deductible
100% Coinsurance
Acupuncture
Not covered
Not covered
Rehabilitative Occupational and Rehabilitative Physical Therapy
40% Coinsurance after deductible
100% Coinsurance
Well Baby Visits and Care
No Charge
100% Coinsurance
Allergy Testing
40% Coinsurance after deductible
100% Coinsurance
Diabetes Education
40% Coinsurance after deductible
100% Coinsurance
Nutritional Counseling
40% Coinsurance after deductible
100% Coinsurance
Eye Exam for Children
No Charge
100% Coinsurance
Eyeglasses for Children
40% Coinsurance after deductible
100% Coinsurance
Hearing Aids for Children
40% Coinsurance after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not covered
Not covered
Basic Dental (Child)
Not covered
Not covered
Dental Checkup (Child)
Not covered
Not covered
Major Dental Care (Adult)
Not covered
Not covered
Major Dental Care (Child)
Not covered
Not covered