Best Buy HSA HMO 5400 Plan Details for 2020- HealthPocket

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Zip Code04401
Applicant2/27/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBest Buy HSA HMO 5400
Plan IDqhp-96667ME0240024
Plan Year2019
Insurance ProviderHarvard Pilgrim
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,400
Out-of-Pocket Maximum$6,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness30% Coinsurance after deductible
Specialist Visit30% Coinsurance after deductible
Deductible - Family$10800
Out-of-Pocket Maximum - Family$13100

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs40% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs40% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.providerlookuponline.com/Harvardpilgrim/po7/gateway.aspx?clientprodcode=3465439

Hospital services

Emergency Room Services30% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30% Coinsurance after deductible
Inpatient Physician and Surgical Services30% Coinsurance after deductible
PremiumPlan NameDeductible
from $402
Community Align PPO
$5,500.00Select
from $423
HMO HSA Bronze 5400
$5,400.00Select
from $447
Community Focus PPO
$5,500.00Select
from $486
Community Align PPO
$5,500.00Select
from $629
Community Plus HMO
$5,500.00Select
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  • Phone Number
    (207) 942-3988
  • Office Locations
    277 State St
    Bangor, ME 04401
277 State St Bangor ME, 04401

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).