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
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

/
YOO, SOOK
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SCHINDLER, ALAN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
BELL, GEORGE
101 E OLNEY AVE
PHILADELPHIA, PA 19120
YOO, STANLEY
101 E OLNEY AVE
PHILADELPHIA, PA 19120
AHSAN, SYED
101 E OLNEY AVE
PHILADELPHIA, PA 19120
BRADY, PAUL
101 E OLNEY AVE
PHILADELPHIA, PA 19120
MATSON, DAVID
101 E OLNEY AVE
PHILADELPHIA, PA 19120
GARCIA, LAUREANO
328 W GODFREY AVE
PHILADELPHIA, PA 19120
STEERMAN, PAUL
101 E OLNEY AVE
PHILADELPHIA, PA 19120
NGUYEN, TRUONG
5746 RISING SUN AVE
PHILADELPHIA, PA 19120
BLENDER, BURTON
335 E WYOMING AVE
PHILADELPHIA, PA 19120
TADLEY, GERALD
335 E WYOMING AVE
PHILADELPHIA, PA 19120
ESQUENAZI, ALBERTO
101 E OLNEY AVE
PHILADELPHIA, PA 19120
SMALL, RONALD
104 W CHELTENHAM AVE
PHILADELPHIA, PA 19120
GRANT, RICHARD
101 E OLNEY AVE
PHILADELPHIA, PA 19120
MASSEY, JULIE
101 E OLNEY AVE
PHILADELPHIA, PA 19120
NGUYEN, KENNETH
448 E WYOMING AVE
PHILADELPHIA, PA 19120
MYERS, JOHN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ITSKOV, BORIS
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ROSENSTEIN, KENNETH
101 E OLNEY AVE
PHILADELPHIA, PA 19120
STANILLA, JOSEPH
101 E OLNEY AVE
PHILADELPHIA, PA 19120
ROSEN, HOWARD
101 E OLNEY AVE
PHILADELPHIA, PA 19120
HAILS, KEVIN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
BEST, KIMBERLY
101 E OLNEY AVE
PHILADELPHIA, PA 19120
HOELLEIN, KENNETH
101 E OLNEY AVE
PHILADELPHIA, PA 19120
Details
SOOK YOO, MD
Phone Number
(215) 456-7000
Office Locations
101 E OLNEY AVE
PHILADELPHIA, PA 19120
101 E OLNEY AVE PHILADELPHIA PA, 19120

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