2019 Blue Shield Silver 70 Trio HMO Plan Details - HealthPocket

Blue Shield Silver 70 Trio HMO

$0.00/mo

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Zip Code90011
Applicant12/10/1983 Male
Coverage Start12/11/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Shield Silver 70 Trio HMO
Plan IDexch-CA2019BlueShieldSilver70TrioHMO
Plan Year2019
Insurance ProviderAnthem Blue Cross
Metal LevelSilver
Plan TypeHMO
Deductible$2,500
Out-of-Pocket Maximum$7,550
Plan Highlights

Yearly Deductible & Out-of-Pocket

Yearly Deductible - Individual$2500
Yearly Deductible - Family$5000
Separate Drug Deductible - Individual$200
Separate Drug Deductible - Family$400
Out-of-Pocket Max - Individual$7550
Out-of-Pocket Max - Family$15100
Maximum Cost per Prescription$250

Doctor Visit

Primary Care Visit$40 Copay
Specialist Visit$80 Copay
Other Practitioner Office Visit$40 Copay
Preventive Care/Screening/ImmunizationNo Charge

Tests

Laboratory Tests$35 Copay
X-rays and Diagnostic Imaging$75 Copay
Imaging (CT/PET Scans, MRIs)$300 Copay

Drugs

Tier 1 (Most Generic Drugs)$15 Copay after deductible
Tier 2 (Preferred Brand Drugs)$55 Copay after deductible
Tier 3 (Non-Preferred Brand Drugs)$80 Copay after deductible
Tier 4 (Specialty Drugs)20% Coinsurance after deductible

Outpatient Services

Outpatient Facility Fee20% Coinsurance
Outpatient Surgery Physician/Surgical Services20% Coinsurance
Outpatient Services Office Visits20% Coinsurance

ER & Urgent Care

Emergency Room Facility Fee$350 Copay
Emergency Transportation$250 Copay after deductible
Urgent Care$40 Copay
Emergency Room Professional FeeNo Charge

Hospital

Inpatient Hospital Services20% Coinsurance after deductible
Inpatient Physician and Surgical Services20% Coinsurance

Mental/Behavioral Health

Mental/Behavioral Health Outpatient Services$40 Copay
Mental/Behavioral Health Inpatient Facility Fee20% Coinsurance after deductible
Mental/Behavioral Health Inpatient Professional Fee20% Coinsurance
Substance Use Disorder Outpatient Services$40 Copay
Substance Use Disorder Inpatient Facility Fee20% Coinsurance after deductible

Pregnancy

Prenatal CareNo Charge
Delivery and Maternity Care Inpatient Facility Fee20% Coinsurance after deductible
Delivery and Maternity Care Inpatient Professional Fee20% Coinsurance

Other Special Needs

Home Health Care Services$45 Copay
Outpatient Rehabilitation Services$40 Copay
Habilitation Services$40 Copay
Skilled Nursing Facility20% Coinsurance after deductible
Durable Medical Equipment20% Coinsurance
Hospice ServicesNo Charge
Acupuncture$40 Copay
Rehabilitative Speech Therapy$40 Copay
Rehabilitative Occupational and Rehabilitative Physical Therapy$40 Copay
Well Baby Visits and CareNo Charge
Allergy Testing$80 Copay
Diabetes EducationNo Charge
Nutritional CounselingNot covered

Children's Vision

Eye Exam for ChildrenNo Charge
Eyeglasses for ChildrenNo Charge

Children's Dental

Child Filling - One Surface20% Coinsurance
Child Dental CheckupNo Charge
Child Root Canal - Molar50% Coinsurance
Child Medically Necessary Orthodontia50% Coinsurance
PremiumPlan NameDeductible
from $334
Silver 70 Off Exchange CommunityCare HMO
$2,500.00Select
from $388
Silver 70 CommunityCare HMO
$2,500.00Select
from $456
WHA Silver 70 Off Exchange HMO
$2,500.00Select
from $457
Silver 70 HMO Off Exchange
$2,500.00Select
from $475
Silver 70 Off Exchange EPO
$2,500.00Select
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  • Phone Number
    (323) 233-0425
  • Office Locations
    4211 Avalon Blvd
    Los Angeles, CA 90011
4211 Avalon Blvd Los Angeles CA, 90011
  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.