Personal Choice PPO $5000 H.S.A

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
Personal Choice PPO $5000 H.S.A
Plan ID
31609PA0030005
Plan Year
2013
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Independence Blue Cross
Plan Type
PPO
Deductible
$5,000
Out-of-Pocket Maximum
$5,000
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

Physician Directory

List of doctors that accepts Personal Choice PPO $5000 H.S.A Plan in Pennsylvania

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PUBLIC HEALTH MANAGEMENT CORP
500 ADAMS AVENUE
PHILADELPHIA, PA 19120
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
KORRAPATI, VAMSIMADHAV
100 E LEHIGH AVE
PHILADELPHIA, PA 19125
PERRE, ANTHONY
1331 E WYOMING 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
LEONARD, EDWARD
4641 ROOSEVELT BLVD
PHILADELPHIA, PA 19124
HERRINE, GAIL
2301 E ALLEGHENY AVE
PHILA, PA 19134
QUIEN, EMMANUEL
2301 E ALLEGHENY AVE
PHILADELPHIA, PA 19134
SHIN, MYUNG
2301 E ALLEGHENY AVE
PHILA, PA 19134
TEMPLE PHYSICIANS INC
2301 E ALLEGHENY AVENUE
PHILADELPHIA, PA 19134
GEORGE L. RODRIGUEZ, M.D., P.C.
841 E ALLEGHENY AVE
PHILADELPHIA, PA 19134
GEORGE L. RODRIGUEZ, M.D., P.C.
841 E ALLEGHENY AVE
PHILADELPHIA, PA 19134
DAVIES, ROBERT
2301 E ALLEGHENY AVE
PHILADELPHIA, PA 19134
MILLER, PAUL
7600 CENTRAL AVE
PHILADELPHIA, PA 19111
LORICO, ABEGAEL
7602 CENTRAL AVE
PHILA, PA 19111
AUERBACH, ROBERT
7602 CENTRAL AVE
PHILA, PA 19111
Details
PUBLIC HEALTH MANAGEMENT CORP
Phone Number
(215) 279-6666
Office Locations
500 ADAMS AVENUE
PHILADELPHIA, PA 19120
500 ADAMS AVENUE PHILADELPHIA PA, 19120

Community Q&A

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