PrimarySelect Silver Plan

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
PrimarySelect Silver
Plan ID
71644NY0030002
Plan Year
2014
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Health Republic Insurance of New York
Metal Level
Silver
Plan Type
EPO
Deductible
$2,000
Out-of-Pocket Maximum
$6,350
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $1103.36
Deductible
Individual: $2000
Family: $4000
In-Network Out-of-Pocket Limit
Individual: $6350
Family: $12700
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
$0 Copay
Not Covered
Specialist
$75 Copay
Not Covered
Diagnostic Test (X-ray, blood work)
$75 Copay
Not Covered
Outpatient Facility Fee
20% Coinsurance after deductible
Not Covered
Outpatient Physician/Surgeon Fee
20% Coinsurance after deductible
Not Covered
Hospital facility fee
20% Coinsurance after deductible
Not Covered
Hospital physician/surgeon fee
$150 Copay after deductible
Not Covered
Emergency Room
$250 Copay after deductible
$250 Copay after deductible

Drug Services

Generic Drugs
Coverage: $0 Copay
Preferred Brand Drugs
Coverage: $35 Copay after deductible
Specialty Drugs
Coverage: $70 Copay after deductible

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
$0 Copay
Not Covered
Mental/behavioral health inpatient services
20% Coinsurance after deductible
Not Covered
Substance use disorder inpatient services
20% Coinsurance after deductible
Not Covered
Substance use disorder outpatient services
$0 Copay
Not Covered

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
No Charge
Not Covered
Delivery and all inpatient services for maternity care
20% Coinsurance after deductible
Not Covered

Coverage Options Summary

Included Benefits
  • Acupuncture
  • Bariatric surgery
  • Chiropractic
  • Durable medical equipment
  • Emergency Transportation
  • Eye glasses children
  • Habilitation
  • Hearing Aid
  • 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
  • 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

What To Know

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

Physician Directory

List of doctors that accepts PrimarySelect Silver Plan Obamacare Plan in New york

/
BANCHIK, MARK
90-02 QUEENS BLVD
ELMHURST, NY 11373
SINGH, BHUPINDER
10923 JAMAICA AVE
RICHMOND HILL, NY 11418
Details
MARK BANCHIK, M.D.
Phone Number
(718) 558-1870
Office Locations
90-02 QUEENS BLVD
ELMHURST, NY 11373
90-02 QUEENS BLVD ELMHURST NY, 11373

Community Q&A

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