Benefits & Coverage

Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Health Republic Insurance of New York
Metal Level
Silver
Plan Type
EPO
Deductible
$2000
Out-of-Pocket Maximum
$5500
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $1104.15
Deductible
Individual: $2000
Family: $4000
In-Network Out-of-Pocket Limit
Individual: $5500
Family: $11000
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
EPO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
$30 Copay after deductible
Not Covered
Specialist
$50 Copay after deductible
Not Covered
Diagnostic Test (X-ray, blood work)
$50 Copay after deductible
Not Covered
Outpatient Facility Fee
$100 Copay after deductible
Not Covered
Outpatient Physician/Surgeon Fee
$100 Copay after deductible
Not Covered
Hospital facility fee
$1500 Copay after deductible
Not Covered
Hospital physician/surgeon fee
$100 Copay after deductible
Not Covered
Emergency Room
$150 Copay after deductible
$150 Copay after deductible

Drug Services

Generic Drugs
Coverage: $10 Copay
Preferred Brand Drugs
Coverage: $35 Copay
Specialty Drugs
Coverage: $70 Copay

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
$30 Copay after deductible
Not Covered
Mental/behavioral health inpatient services
$1500 Copay after deductible
Not Covered
Substance use disorder inpatient services
$1500 Copay after deductible
Not Covered
Substance use disorder outpatient services
$30 Copay after deductible
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
$1500 Copay after deductible
Not Covered

Coverage Options Summary

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

What To Know

  • This is an ACA (Obamacare) compliant health plan.

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