Benefits & Coverage

Insurance Type
Individual Health Insurance
Insurance Provider
CoventryOne
Plan Type
POS
Deductible
Not Applicable
Out-of-Pocket Maximum
Not Applicable
Plan Highlights

    Cost & Coverage

    Estimated Monthly Base Rate
    Estimated monthly premium starts at $80.06
    How many applications are denied?
    14% of the applicants were denied
    How accurate is this estimate?
    19% of the applicants ended up paying a higher amount than the quoted price
    Deductible
    Individual: N/A
    Family: $9000
    In-Network Out-of-Pocket Limit
    Individual: N/A
    Family: $9000
    What is included in the in-network out-of-pocket limit?
    Deductible + Coinsurance + Co-pay
    Is this plan Health Savings Account (HSA) eligible?
    No
    How can I find a doctor in this plan's network?
    Plan Type
    POS

    Health Services Options

    Service
    In Network
    Out of Network
    Primary care physician office visit
    No Charge after deductible
    30% Coinsurance after deductible
    Specialist
    No Charge after deductible
    30% Coinsurance after deductible
    Diagnostic Test (X-ray, blood work)
    No Charge after deductible
    30% Coinsurance after deductible
    Outpatient Facility Fee
    No Charge after deductible
    30% Coinsurance after deductible
    Outpatient Physician/Surgeon Fee
    No Charge after deductible
    30% Coinsurance after deductible
    Hospital facility fee
    No Charge after deductible
    30% Coinsurance after deductible
    Hospital physician/surgeon fee
    No Charge after deductible
    30% Coinsurance after deductible
    Emergency Room
    No Charge after deductible
    No Charge after deductible

    Drug Services

    Generic Drugs
    Coverage: No Charge after deductible
    Preferred Brand Drugs
    Coverage: No Charge after deductible
    Specialty Drugs
    Coverage: No Charge after deductible
    What drugs are covered in the formulary?

    Mental Health or Substance Abuse Services

    Service
    In Network
    Out of Network
    Mental/behavioral health outpatient services
    Not Covered
    Not Covered
    Mental/behavioral health inpatient services
    Not Covered
    Not Covered
    Substance use disorder inpatient services
    Not Covered
    Not Covered
    Substance use disorder outpatient services
    Not Covered
    Not Covered

    Maternity Services

    Service
    In Network
    Out of Network
    Prenatal/postnatal care
    Not Covered
    Not Covered
    Delivery and all inpatient services for maternity care
    Not Covered
    Not Covered

    Coverage Options Summary

    Included Benefits
    • Durable medical equipment
    • Emergency Transportation
    • Home health care
    • Hospice
    • Imaging (CT/PET scans, MRIs)
    • Inpatient rehabilitation
    • Non-preferred brand drugs
    • Skilled nursing care
    • Other practitioner office visit
    • Outpatient rehabilitation
    • Preventive care, screening, immunization
    • Routine eye exam children
    • Urgent Care
    Excluded Benefits
    • Acupuncture
    • Bariatric surgery
    • Cosmetic surgery
    • Dental care adult
    • Dental check up children
    • Eye exam adult
    • Eye glasses children
    • Habilitation
    • Hearing Aid
    • Infertility treatment
    • Long Term Care
    • Non-emergency care outside U.S.
    • Private duty nursing
    • Routine foot care
    • Routine hearing tests
    • Weight loss program
    Limited Benefits
    • Chiropractic

    What To Know

    • 14%of the applicants were denied
    • 19%of the applicants ended up paying a higher amount than the quoted price
    • Deductible amount is NOT included as part of the out-of-pocket limit

    Physician Directory

    List of doctors that accepts CoventryOne QHDHP 10 (Family) Plan in South carolina

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