Sentara Health Plans - Sentara Silver 300 Ded (05)
Sample Care Costs
Having a baby
$2650
Having diabetes
$700
Treatment of a simple fracture
$1380
Primary Care Visit
$20 Copay
100% Coinsurance
Specialist Visit
$75 Copay
100% Coinsurance
Other Practitioner Office Visit (Nurse, Physician Assistant)
25% Coinsurance after deductible
100% Coinsurance
Preventive Care/Screening/Immunization
No Charge
100% Coinsurance
Laboratory Outpatient and Professional Services
25% Coinsurance after deductible
100% Coinsurance
X-rays and Diagnostic Imaging
25% Coinsurance after deductible
100% Coinsurance
Imaging (CT/PET scans, MRIs)
25% Coinsurance after deductible
100% Coinsurance
Generic Drugs
$15 Copay
100% Coinsurance
Preferred Brand Drugs
$50 Copay
100% Coinsurance
Non-Preferred Brand Drugs
35% Coinsurance after deductible
100% Coinsurance
Specialty drugs
35% Coinsurance after deductible
100% Coinsurance
Outpatient Facility Fee
25% Coinsurance after deductible
100% Coinsurance
Outpatient Surgery Physician/Surgical Services
25% Coinsurance after deductible
100% Coinsurance
Emergency Room Services
45% Coinsurance after deductible
45% Coinsurance after deductible
Emergency Transportation/Ambulance
45% Coinsurance after deductible
45% Coinsurance after deductible
Urgent Care
$50 Copay
100% Coinsurance
Inpatient Hospital Services
25% Coinsurance after deductible
100% Coinsurance
Inpatient Physician and Surgical Services
25% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Outpatient Services
25% Coinsurance after deductible
100% Coinsurance
Mental/Behavioral Health Inpatient Services
25% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Outpatient Services
25% Coinsurance after deductible
100% Coinsurance
Substance Abuse Disorder Inpatient Services
25% Coinsurance after deductible
100% Coinsurance
Prenatal and postnatal care
25% Coinsurance after deductible
100% Coinsurance
Delivery and All Inpatient Services for Maternity Care
25% Coinsurance after deductible
100% Coinsurance
Home Healthcare Services
25% Coinsurance after deductible
100% Coinsurance
Outpatient Rehabilitation Services
25% Coinsurance after deductible
100% Coinsurance
Habilitation Services
25% Coinsurance after deductible
100% Coinsurance
Skilled Nursing Facility
25% Coinsurance after deductible
100% Coinsurance
Durable Medical Equipment
25% Coinsurance after deductible
100% Coinsurance
Hospice Services
25% Coinsurance after deductible
100% Coinsurance
Chiropractic Care
25% Coinsurance after deductible
100% Coinsurance
Acupuncture
Not Covered
Not Covered
Rehabilitative Speech Therapy
25% Coinsurance after deductible
100% Coinsurance
Rehabilitative Occupational and Rehabilitative Physical Therapy
25% Coinsurance after deductible
100% Coinsurance
Well Baby Visits and Care
No Charge
100% Coinsurance
Allergy Testing
25% Coinsurance after deductible
100% Coinsurance
Diabetes Education
No Charge
100% Coinsurance
Nutritional Counseling
25% Coinsurance after deductible
100% Coinsurance
Eye Exam for Children
No Charge
100% Coinsurance
Eye Glasses for Children
No Charge
100% Coinsurance
Accidental Dental
25% Coinsurance after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not Covered
Not Covered
Basic Dental Care (Child)
Not Covered
Not Covered
Dental Check Up (Child)
Not Covered
Not Covered
Major Dental Care (Adult)
Not Covered
Not Covered
Major Dental Care (Child)
Not Covered
Not Covered
Orthodontia (Adult)
Not Covered
Not Covered
Orthodontia (Child)
Not Covered
Not Covered
Routine Dental Services (Adult)
Not Covered
Not Covered