2023 Silver Plans

Silver Plans Overview

Once you understand the differences, it鈥檚 easier to find the best plan that fits you and your family. We want you to get all the coverage you need without paying for benefits you don鈥檛.

Silver cheat sheet:

Silver plans have mid-range premiums.
Silver plans have mid-range out-of-pocket costs.
On average, the insurance company pays 70%. You pay 30%.
鈥淭he comprehensive plan balanced with affordability.鈥�

Questions?

Our hours of operation
are 8 a.m. 鈥� 5 p.m.

Call Us:
Local: 713.295.6704
Toll-Free: 1.855.315.5386

All 黑暗爆料官方 plans come with:

Preventive Services

One of the largest Provider
and facilities network in
Southeast Texas

Low copay on many
generic drugs

Most primary care visits,
specialist visits, urgent care, and generic drugs are not subject to deductible

Free 24/7 telehealth

No referrals needed
for specialists

Which Silver plan is right for you?

Premier Silver 004
Premier Silver 012
Premier Silver 013
Select Silver 019
Premier Silver 020

PREMIER SILVER PLAN 004

HIGHER PREMIUMS
LOW TO MODERATE COST-SHARING

Plan Overview

Important Features of 2023 Premier Silver 004 Plan:

Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment.听If you鈥檙e eligible, you can apply it to any Silver plan.

View Quick Reference Guide

Summary of Benefits
and Coverage

View 2023 Premier Silver 004 Details

Medical Deductible (Individual) Medical and Drug:
$3,300
Maximum Out-of-Pocket (Individual)
$9,100
Primary Care Physician Office Visit
$30*
Specialist Office Visit
$60*
Urgent Care Visit
$60*
Emergency Room Visit
40%

Inpatient Hospital Stay
40%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$70
Non-Preferred Brand
$110
Specialty High-Cost Drugs
50%

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic Rx)

View 2023 Premier Silver 004 CSR 73 Plan Details

Medical Deductible (Individual):
$3,200
Maximum Out-of-Pocket (Individual)
$7,250
Primary Care Physician Office Visit
$30*
Specialist Office Visit
$60*
Urgent Care Visit
$60*
Emergency Room Visit
40%

Inpatient Hospital Stay
40%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$60
Non-Preferred Brand
$110
Specialty High-Cost Drugs
40%

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic Rx)

View 2023 Premier Silver 004 CSR 87 Plan Details

Medical Deductible (Individual):
N/A
Maximum Out-of-Pocket (Individual)
$2,900
Primary Care Physician Office Visit
$25
Specialist Office Visit
$50
Urgent Care Visit
$50
Emergency Room Visit
40%

Inpatient Hospital Stay
40%
Prescription Drug Deductible
N/A
Generic
$10
Preferred Brand
$50
Non-Preferred Brand
$85
Specialty High-Cost Drugs
30%

View 2023 Premier Silver 004 CSR 94 Plan Details

Medical Deductible (Individual):
N/A
Maximum Out-of-Pocket (Individual)
$2,000
Primary Care Physician Office Visit
$10
Specialist Office Visit
$20
Urgent Care Visit
$20
Emergency Room Visit
10%

Inpatient Hospital Stay
10%
Prescription Drug Deductible
N/A
Generic
$5
Preferred Brand
$20
Non-Preferred Brand
$40
Specialty High-Cost Drugs
20%

PREMIER SILVER PLAN 012

HIGHER PREMIUMS
LOW TO MODERATE COST-SHARING

Plan Overview

Important Features of 2023 Premier Silver 12 Plan:

Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment.听If you鈥檙e eligible, you can apply it to any Silver plan.

View Quick Reference Guide

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost

Download PDF

Limited Cost

Download PDF

73% AV Level

Download PDF

87% AV Level

Download PDF

94% AV Level

Download PDF

View 2023 Premier Silver 12 Plan Details

Medical Deductible (Individual) Medical and Drug:
$3,000
Maximum Out-of-Pocket (Individual)
$9,100
Primary Care Physician Office Visit
$30*
Urgent Care Visit
$60*
Emergency Room Visit
50%

Inpatient Hospital Stay
50%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$80
Non-Preferred Brand
$120
Specialty High-Cost Drugs
50%

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic Rx)

View 2023 Premier Silver 12 CSR 73 Plan Details

Medical Deductible (Individual):
$2,500
Maximum Out-of-Pocket (Individual)
$6,950
Primary Care Physician Office Visit
$30*
Urgent Care Visit
$60*
Emergency Room Visit
50%

Inpatient Hospital Stay
50%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$80
Non-Preferred Brand
$120
Specialty High-Cost Drugs
50%

* Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Premier Silver 12 CSR 87 Plan Details

Medical Deductible (Individual):
$500
Maximum Out-of-Pocket (Individual)
$2,500
Primary Care Physician Office Visit
$25*
Specialist Office Visit
$50
Urgent Care Visit
$50*
Emergency Room Visit
40%

Inpatient Hospital Stay
40%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$5*
Preferred Brand
$70
Non-Preferred Brand
$1000
Specialty High-Cost Drugs
40%

* Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Premier Silver 12 CSR 94 Plan Details

Medical Deductible (Individual):
N/A
Maximum Out-of-Pocket (Individual)
$1,800
Primary Care Physician Office Visit
$10
Specialist Office Visit
$20
Urgent Care Visit
$20
Emergency Room Visit
10%

Inpatient Hospital Stay
10%
Prescription Drug Deductible
N/A
Generic
$5
Preferred Brand
$20
Non-Preferred Brand
$40
Specialty High-Cost Drugs
20%

听

PREMIER SILVER PLAN 013

HIGHER PREMIUMS
LOW TO MODERATE COST-SHARING

Plan Overview

Important Features of 2023 Premier Silver 13 Plan:

Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment.听If you鈥檙e eligible, you can apply it to any Silver plan.

View Quick Reference Guide

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost

Download PDF

Limited Cost

Download PDF

73% AV Level

Download PDF

87% AV Level

Download PDF

94% AV Level

Download PDF

View 2023 Premier Silver 13 Plan Details

Medical Deductible (Individual)
$8,500
Maximum Out-of-Pocket (Individual)
$8,500
Primary Care Physician Office Visit
$10*
Specialist Office Visit
$20*
Urgent Care Visit
$20*
Emergency Room Visit
No charge after deductible

Inpatient Hospital Stay
No charge after deductible
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
No charge after deductible
Non-Preferred Brand
No charge after deductible
Specialty High-Cost Drugs
No charge after deductible

*Services are exempt from deductible where indicated (PCP/Urgent Care/Generic Rx)

View 2023 Premier Silver 13 CSR 73 Plan Details

Medical Deductible (Individual):
$6,800
Maximum Out-of-Pocket (Individual)
$6,800
Primary Care Physician Office Visit
$10*
Specialist Office Visit
$15
Urgent Care Visit
$20*
Emergency Room Visit
No charge after deductible

Inpatient Hospital Stay
No charge after deductible
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
No charge after Deductible
Non-Preferred Brand
No charge after Deductible
Specialty High-Cost Drugs
No charge after Deductible

* Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Premier Silver 13 CSR 87 Plan Details

Medical Deductible (Individual):
$2,200
Maximum Out-of-Pocket (Individual)
$2,200
Primary Care Physician Office Visit
$10*
Specialist Office Visit
$15*
Urgent Care Visit
$15*
Emergency Room Visit
No charge after deductible

Inpatient Hospital Stay
No charge after deductible
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
No charge after deductible
Non-Preferred Brand
No charge after deductible
Specialty High-Cost Drugs
No charge after deductible

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Premier Silver 13 CSR 94 Plan Details

Medical Deductible (Individual):
$700
Maximum Out-of-Pocket (Individual)
$700
Primary Care Physician Office Visit
$5*
Specialist Office Visit
$10*
Urgent Care Visit
$10*
Emergency Room Visit
No charge after deductible

Inpatient Hospital Stay
No charge after deductible
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
No charge after deductible
Non-Preferred Brand
No charge after deductible
Specialty High-Cost Drugs
No charge after deductible

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

SELECT SILVER PLAN 019

HIGHER PREMIUMS
LOW TO MODERATE COST-SHARING

Plan Overview

Important Features of 2023 Select Silver 19 Plan:

Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment.听If you鈥檙e eligible, you can apply it to any Silver plan.

View Quick Reference Guide

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost Variation

Download PDF

AI/AN Limited Cost

Download PDF

73% AV Level

Download PDF

87% AV Level

Download PDF

94% AV Level

Download PDF

View 2023 Select Silver 19 Details

Medical Deductible (Individual)
$4,900
Maximum Out-of-Pocket (Individual)
$9,100
Primary Care Physician Office Visit
$30*
Specialist Office Visit
$80*
Urgent Care Visit
$80*
Emergency Room Visit
30%

Inpatient Hospital Stay
30%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$40
Non-Preferred Brand
$80
Specialty High-Cost Drugs
50%

*Services are exempt from deductible where indicated (PCP/Urgent Care/Generic Rx)

View 2023 Select Silver 19 CSR 73 Plan Details

Medical Deductible (Individual):
$4,900
Maximum Out-of-Pocket (Individual)
$9,100
Primary Care Physician Office Visit
$30*
Specialist Office Visit
$80*
Urgent Care Visit
$80*
Emergency Room Visit
30%

Inpatient Hospital Stay
30%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$40
Non-Preferred Brand
$80
Specialty High-Cost Drugs
50%

*Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Select Silver 19 CSR 87 Plan Details

Medical Deductible (Individual):
$500
Maximum Out-of-Pocket (Individual)
$3,000
Primary Care Physician Office Visit
$20*
Specialist Office Visit
$40*
Urgent Care Visit
$40*
Emergency Room Visit
30%

Inpatient Hospital Stay
30%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$25
Non-Preferred Brand
$60
Specialty High-Cost Drugs
50%

* Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Select Silver 19 CSR 94 Plan Details

Medical Deductible (Individual):
N/A
Maximum Out-of-Pocket (Individual)
$1,500
Primary Care Physician Office Visit
$5
Specialist Office Visit
$25
Urgent Care Visit
$25
Emergency Room Visit
10%

Inpatient Hospital Stay
10%
Prescription Drug Deductible
N/A
Generic
$5
Preferred Brand
$15
Non-Preferred Brand
$40
Specialty High-Cost Drugs
30%

PREMIER SILVER PLAN 020

HIGHER PREMIUMS
LOW TO MODERATE COST-SHARING

Plan Overview

Important Features of 2023 Premier Silver 20 Plan:

Things to Keep in Mind:

The Advanced Premium Tax Credit can lower your monthly payment.听If you鈥檙e eligible, you can apply it to any Silver plan.

View Quick Reference Guide

Summary of Benefits
and Coverage

Off-Exchange

Download PDF

On-Exchange

Download PDF

Zero Cost Variation

Download PDF

AI/AN Limited Cost

Download PDF

73% AV Level

Download PDF

87% AV Level

Download PDF

94% AV Level

Download PDF

View 2023 Premier Silver 20 Plan Details

Medical Deductible (Individual)
$5,800
Maximum Out-of-Pocket (Individual)
$8,900
Primary Care Physician Office Visit
$40*
Specialist Office Visit
$80*
Urgent Care Visit
$60*
Emergency Room Visit
40%

Inpatient Hospital Stay
40%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$20*
Preferred Brand
$40*
Non-Preferred Brand
$80
Specialty High-Cost Drugs
$350

*Services are exempt from deductible where indicated (PCP/Urgent Care/Generic Rx)

View 2023 Premier Silver 20 CSR 73 Plan Details

Medical Deductible (Individual):
$5,700
Maximum Out-of-Pocket (Individual)
$7,200
Primary Care Physician Office Visit
$30*
Specialist Office Visit
$60*
Urgent Care Visit
$45*
Emergency Room Visit
40%

Inpatient Hospital Stay
40%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$20*
Preferred Brand
$40*
Non-Preferred Brand
$80
Specialty High-Cost Drugs
$350

* Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Premier Silver 20 CSR 87 Plan Details

Medical Deductible (Individual):
$800
Maximum Out-of-Pocket (Individual)
$3,000
Primary Care Physician Office Visit
$20*
Specialist Office Visit
$40*
Urgent Care Visit
$30*
Emergency Room Visit
30%

Inpatient Hospital Stay
30%
Prescription Drug Deductible
Combined with Medical Deductible
Generic
$10*
Preferred Brand
$20*
Non-Preferred Brand
$60
Specialty High-Cost Drugs
$250

* Services are exempt from deductible where indicated (PCP/Specialist/Urgent Care/Generic RX)

View 2023 Premier Silver 20 CSR 94 Plan Details

Medical Deductible (Individual):
N/A
Maximum Out-of-Pocket (Individual)
$1,700
Primary Care Physician Office Visit
$0
Specialist Office Visit
$10
Urgent Care Visit
$5
Emergency Room Visit
25%

Inpatient Hospital Stay
25%
Prescription Drug Deductible
N/A
Generic
$0
Preferred Brand
$15
Non-Preferred Brand
$50
Specialty High-Cost Drugs
$150

Local and Neighborly

What does it mean when we say we are local? It means that our service area is 20 counties in the Greater Houston and Beaumont areas. It means that our Providers and facilities are near to you. That鈥檚 why we partner with about 7,500 Providers across 20 counties in Southeast Texas, including doctors and clinics at integrated-care organizations. The doctors and facilities and specialists that you see in your times of need are nearby and neighborly.

Why Choose 黑暗爆料官方?

As a local nonprofit health plan, 黑暗爆料官方 gives you plenty of reasons to join our 黑暗爆料官方. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, 黑暗爆料官方 is always working life forward for you and your family.

鈥満诎当瞎俜� is always there to answer my questions and help me and my family with our medical needs. I truly appreciate and value their customer support and service.鈥�
鈥� Cecily
Member of 黑暗爆料官方

黑暗爆料官方