VantageBlue Direct Plan 1500/3000

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
VantageBlue Direct 1500/3000
Plan ID
15287RI0270002
Plan Year
2013
Insurance Type
Individual Health Insurance (Obamacare)
Plan Type
PPO
Deductible
$1,500
Out-of-Pocket Maximum
$4,500
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $177.45
How many applications are denied?
3% of the applicants were denied
How accurate is this estimate?
0% of the applicants ended up paying a higher amount than the quoted price
Deductible
Individual: $1500
Family: $3000
In-Network Out-of-Pocket Limit
Individual: $4500
Family: $9000
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance
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
$20 Copay
40% Coinsurance after deductible
Specialist
$40 Copay
40% Coinsurance after deductible
Diagnostic Test (X-ray, blood work)
20% Coinsurance after deductible
40% Coinsurance after deductible
Outpatient Facility Fee
20% Coinsurance after deductible
40% Coinsurance after deductible
Outpatient Physician/Surgeon Fee
20% Coinsurance after deductible
40% Coinsurance after deductible
Hospital facility fee
20% Coinsurance after deductible
40% Coinsurance after deductible
Hospital physician/surgeon fee
20% Coinsurance after deductible
40% Coinsurance after deductible
Emergency Room
$200 Copay
$200 Copay

Drug Services

Generic Drugs
Coverage: $10 Copay
Preferred Brand Drugs
Coverage: $35 Copay
Specialty Drugs
Coverage: $100 Copay
What drugs are covered in the formulary?

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
No Charge
40% Coinsurance after deductible
Mental/behavioral health inpatient services
20% Coinsurance after deductible
40% Coinsurance after deductible
Substance use disorder inpatient services
20% Coinsurance after deductible
40% Coinsurance after deductible
Substance use disorder outpatient services
No Charge
40% Coinsurance after deductible

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
20% Coinsurance after deductible
40% Coinsurance after deductible
Delivery and all inpatient services for maternity care
20% Coinsurance after deductible
40% Coinsurance after deductible

Coverage Options Summary

Included Benefits
  • Bariatric surgery
  • Chiropractic
  • Durable medical equipment
  • Emergency Transportation
  • Eye exam adult
  • Habilitation
  • Hearing Aid
  • Home health care
  • Hospice
  • Imaging (CT/PET scans, MRIs)
  • Infertility treatment
  • Inpatient rehabilitation
  • Non-emergency care outside U.S.
  • 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 glasses children
  • Long Term Care
  • Private duty nursing
  • Weight loss program
Limited Benefits
  • Routine foot care

What To Know

  • 3%of the applicants were denied
  • 0%of the applicants ended up paying a higher amount than the quoted price

Physician Directory

List of doctors that accepts VantageBlue Direct Plan 1500/3000 Plan in Rhode island

/
KHATIB, PERVEZ
100 CURTIS ST
PROVIDENCE, RI 02909
BASSEN, DAISY
340 BROADWAY
PROVIDENCE, RI 02909
VANDYCK, WALTER
SPRINGFIELD MIDDLE SCHOOL, PROVIDENE SCHOOL DEPARTMENT
PROVIDENCE, RI 02909
SALAK, JESSICA
100 CURTIS ST
PROVIDENCE, RI 02909
MASTROSTEFANO, PASQUALE
347 BROADWAY
PROVIDENCE, RI 02909
NG, KAREN
100 CYRTIS STREET
PROVIDENCE, RI 02909
CLARK-MEDYESY, MELANIE
176 CONGRESS AVE
PROVIDENCE, RI 02907
SCOTT, WALTER
655 BROAD ST
PROVIDENCE, RI 02907
MUKAND, JON
21 PEACE ST
PROVIDENCE, RI 02907
KELLY, CARRIE
21 PEACE ST
PROVIDENCE, RI 02907
SKURKOVICH, BORIS
239 CRANSTON ST
PROVIDENCE, RI 02907
HODOSH, STEVEN
243 ELMWOOD AVE
PROVIDENCE, RI 02907
THOMAS, LONICE
239 CRANSTON ST
PROVIDENCE, RI 02907
GURNEY, ELLEN
239 CRANSTON ST.
PROVIDENCE, RI 02907
STUTZ, STANLEY
21 PEACE ST
PROVIDENCE, RI 02907
TAMAN, MAGED
21 PEACE STREET
PROVIDENCE, RI 02907
CECE, JOHN
230 RESERVOIR AVE
PROVIDENCE, RI 02907
PHILBIN, SHARON
239 CRANSTON ST
PROVIDENCE, RI 02907
RODRIGUEZ-PERIS, EMILIO
655 BROAD STREET
PROVIDENCE, RI 02907
MAGLIO, DAVID
178 DEXTER ST
PROVIDENCE, RI 02907
GODLEY, FREDERICK
845 N MAIN ST
PROVIDENCE, RI 02904
PIZZARELLO, PETER
868 ADMIRAL ST
PROVIDENCE, RI 02904
SOUTHERN NEW ENGLAND RETINA ASSOCIATES, PC
1 RANDALL SQ
PROVIDENCE, RI 02904
GREENBERG, PAUL
ONE RANDALL SQUARE
PROVIDENCE, RI 02904
REALI MARINI, DIANE
200 HIGH SERVICE AVE
NORTH PROVIDENCE, RI 02904
Details
PERVEZ KHATIB, MD
Phone Number
(401) 444-0540
Office Locations
100 CURTIS ST
PROVIDENCE, RI 02909
100 CURTIS ST PROVIDENCE RI, 02909

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