Benefits & Coverage

Insurance Type
Individual Health Insurance
Insurance Provider
Independence Blue Cross
Plan Type
PPO
Deductible
$5000
Out-of-Pocket Maximum
$5000
Plan Highlights

    Cost & Coverage

    Estimated Monthly Base Rate
    Estimated monthly premium starts at $98.00
    How many applications are denied?
    23% of the applicants were denied
    How accurate is this estimate?
    26% of the applicants ended up paying a higher amount than the quoted price
    Deductible
    Individual: $5000
    Family: $10000
    In-Network Out-of-Pocket Limit
    Individual: $5000
    Family: $10000
    What is included in the in-network out-of-pocket limit?
    Deductible
    Is this plan Health Savings Account (HSA) eligible?
    No
    How can I find a doctor in this plan's network?
    Plan Type
    PPO

    Health Services Options

    Service
    In Network
    Out of Network
    Primary care physician office visit
    No Charge after deductible
    50% Coinsurance after deductible
    Specialist
    No Charge after deductible
    50% Coinsurance after deductible
    Diagnostic Test (X-ray, blood work)
    No Charge after deductible
    50% Coinsurance after deductible
    Outpatient Facility Fee
    No Charge after deductible
    50% Coinsurance after deductible
    Outpatient Physician/Surgeon Fee
    No Charge after deductible
    50% Coinsurance after deductible
    Hospital facility fee
    No Charge after deductible
    50% Coinsurance after deductible
    Hospital physician/surgeon fee
    No Charge after deductible
    50% 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

    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
    • Habilitation
    • 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
    • Urgent Care
    Excluded Benefits
    • Acupuncture
    • Cosmetic surgery
    • Dental care adult
    • Dental check up children
    • Eye exam adult
    • Eye glasses children
    • Hearing Aid
    • Infertility treatment
    • Long Term Care
    • Private duty nursing
    • Routine eye exam children
    • Routine foot care
    • Routine hearing tests
    • Weight loss program
    Limited Benefits
    • Bariatric surgery
    • Chiropractic
    • Non-emergency care outside U.S.

    What To Know

    • 23%of the applicants were denied
    • 26%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 Personal Choice PPO $5000 H.S.A Plan in Pennsylvania

    /
    DOBERCZAK, BOHDAN
    7900 OLD YORK RD
    ELKINS PARK, PA 19027
    KNOX, DAVID
    5924 N BROAD ST
    PHILADELPHIA, PA 19141
    PEREZ-SCHWARTZ, LUZ
    3551 N BROAD ST
    PHILADELPHIA, PA 19140
    LOPEZ-PAJARES, NURIA
    133 W HUNTING PARK AVE
    PHILADELPHIA, PA 19140
    JACOBSON, IRWIN
    4000 N 9TH ST
    PHILA, PA 19140
    LEX, JOSEPH
    3401 N BROAD ST
    PHILADELPHIA, PA 19140
    ESTRADA, JUAN
    3401 N BROAD ST
    PHILADELPHIA, PA 19140
    FERNANDEZ BRANDT, MELINA
    3401 N BROAD ST
    PHILADELPHIA, PA 19140
    BORNSTEIN-CHAU, JUDITH
    2601 HOLME AVE
    PHILADELPHIA, PA 19152
    CHENNUPATI, ANUPAMA
    3401N BROAD ST
    PHILADELPHIA, PA 19140
    WHITLEY, KARL
    3401 N BROAD ST
    PHILA, PA 19140
    TORO-TROCHE, MARIBEL
    133 W HUNTING PARK AVE
    PHILADELPHIA, PA 19140
    KORRAPATI, VAMSIMADHAV
    100 E LEHIGH AVE
    PHILADELPHIA, PA 19125
    CALVO, CARMELA
    3509 N BROAD ST
    PHILADELPHIA, PA 19140
    BARSH, HORACE
    2301 E ALLEGHENY AVE
    PHILADELPHIA, PA 19134
    WILLIS, ALLIRIC
    3401 N BROAD ST
    PHILADELPHIA, PA 19140
    SHAFIA, HASS
    1364 E HUNTING PARK AVE
    PHILADELPHIA, PA 19124
    MARKLEY, FRANK
    1331 E WYOMING AVE
    PHILADELPHIA, PA 19124
    ARIA HEALTH PHYSICIAN SERVICES
    4900 FRANKFORD AVE
    PHILADELPHIA, PA 19124
    SYAMALA, JIJI
    4900 FRANKFORD AVE
    PHILADELPHIA, PA 19124
    GHOSH, SURESH
    5000 FRANKFORD AVE
    PHILADELPHIA, PA 19124
    HANNAH, BRIAN
    FRANKFORD HOSPITAL HEALTH CENTER CLINIC
    PHILADELPHIA, PA 19124
    LEONARD, EDWARD
    4641 ROOSEVELT BLVD
    PHILADELPHIA, PA 19124
    TIJANI, LUKMAN
    602 INDIANA AVE
    LUBBOCK, TX 79415
    HERRINE, GAIL
    2301 E ALLEGHENY AVE
    PHILA, PA 19134
    Details
    BOHDAN DOBERCZAK, M.D.
    Phone Number
    (215) 224-3330
    Office Locations
    7900 OLD YORK RD
    ELKINS PARK, PA 19027
    7900 OLD YORK RD ELKINS PARK PA, 19027

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