Complete HMO HSA 3550 Enhanced FlexRx Plan Details for 2020- HealthPocket

Complete HMO HSA 3550 Enhanced FlexRx

$410.08/mo

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Zip Code02128
Applicant3/29/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameComplete HMO HSA 3550 Enhanced FlexRx
Plan IDhhs-41304MA0021470
Plan Year2020
Insurance ProviderEasy Choice
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$3,550
Out-of-Pocket Maximum$6,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$40 Copay after deductible
Specialist Visit$60 Copay after deductible
Laboratory Outpatient and Professional Services$60 Copay after deductible
X-rays and Diagnostic Imaging$135 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$500 Copay after deductible
Deductible - Family$7100 per group
Out-of-Pocket Maximum - Family$13800 per group

Prescription drug coverage

Generic Drugs$30 Copay after deductible
Preferred Brand Drugs$60 Copay after deductible
Non-Preferred Brand Drugs$150 Copay after deductible
Specialty Drugs$225 Copay after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.allwayshealthpartners.org
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services.
Does this plan cover services outside plan service area?Yes - Urgent and Emergency only
Does this plan cover services outside the country?Yes - Urgent and Emergency only

Hospital services

Emergency Room Services$500 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$1000 Copay per Stay after deductible
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance ServiceNot Applicable

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care$1000 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$40 Copay after deductible
Mental/Behavioral Health Inpatient Services$1000 Copay per Stay after deductible
Substance use disorder outpatient services$40 Copay after deductible
Substance use disorder inpatient services$1000 Copay per Stay after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Bariatric Surgery
Infertility Treatment
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
PremiumPlan NameDeductible
from $358
Focus HMO HSA 3400
$3,400.00Select
from $420
HMO HSA 3400 - Flex
$3,400.00Select
from $437
Complete HMO HSA 3500 Enhanced FlexRx
$3,500.00Select
from $439
HMO 3500 Core - Flex
$3,500.00Select
from $455
PPO HSA 3400 - Flex
$3,400.00Select
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Jackie, Fantes
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Loretta, Chou
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Jan, Dohlman
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Mirriam, Hoffman
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Margareth, Chua
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Jonathan, Hatoun
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Gina, Campanella
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Nairobi, Oller-laureano
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Jacklyn, Giampa
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Mary, Gallagher
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Meghan, Riedy
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Victoria, Shopland
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Jessica, Maclean
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Nairoby, Nunez
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Julia, Bird
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Alison, Carr
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Kelly, Trussell
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Adrianna, D'aurora
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East Boston Physical Therapy Center, Inc.
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Marissa, Gonzalez
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Maureen, Young
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Jackie Fantes, MD
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  • Phone Number
    (617) 569-5800
  • Office Locations
    10 Gove St
    East Boston, MA 02128
10 Gove St East Boston MA, 02128

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HealthPocket.com provides information on insurance products. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Always review the privacy and terms of use of the partner website.

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).