Insurance Type | ACA (Obamacare) |
Plan Name | Blue Advantage Silver HMO? 306 |
Plan ID | hhs-33602TX0460758 |
Plan Year | 2021 |
Insurance Provider | BlueCross BlueShield of Texas |
Metal Level | Silver |
Plan Type | HMO |
Deductible | $2,000 |
Out-of-Pocket Maximum | $8,550 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $25 Copay |
Specialist Visit | 50.00% Coinsurance after deductible |
Laboratory Outpatient and Professional Services | 40.00% Coinsurance after deductible |
X-rays and Diagnostic Imaging | 40.00% Coinsurance after deductible |
Diagnostic Imaging such as MRIs, CT, and PET scans | 40.00% Coinsurance after deductible |
Deductible - Family | $6000 per group |
Out-of-Pocket Maximum - Family | $17100 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | $5 Copay |
Preferred Brand Drugs | $75 Copay |
Non-Preferred Brand Drugs | 35.00% Coinsurance after deductible |
Specialty Drugs | 45.00% Coinsurance after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | http://www.bcbstx.com/onlinedirectory/index.htm |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Yes - Referrals are required for some services. Please check with your Medical Group for details. |
Does this plan cover services outside plan service area? | Yes - Coverage outside our service area is available for Emergency and Urgent Care services only. |
Does this plan cover services outside the country? | Yes - No coverage for any services, supplies or drugs received by a Member outside of the United States, except for Emergency Care. |
Hospital services | |
---|---|
Emergency Room Services | $950 Copay with deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Inpatient Hospital Services (e.g., Hospital Stay) | $850 Copay per Stay with deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Inpatient Physician and Surgical Services | 50.00% Coinsurance after deductible |
Emergency Transportation or Ambulance Service | 50.00% Coinsurance after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | $25 Copay |
Delivery and all inpatient services for maternity care | $850 Copay with deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | 50.00% Coinsurance after deductible |
Mental/Behavioral Health Inpatient Services | $850 Copay per Stay with deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Substance use disorder outpatient services | 50.00% Coinsurance after deductible |
Substance use disorder inpatient services | $850 Copay per Stay with deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
Does this plan offer a wellness program? | Not Covered |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | Included |
Eye Glasses for Children | Included |
Routine Eye Exam for Adults | Not Covered |
Child Dental Coverage | |
---|---|
Child Dental Coverage - Routine Dental Care | Not Covered |
Child Dental Coverage - Basic Dental Care | Not Covered |
Child Dental Coverage - Orthodontia | Not Covered |
Child Dental Coverage - Major Dental Care | Not Covered |
Adult Dental Coverage | |
---|---|
Adult Dental Coverage - Routine Dental Care | Not Covered |
Adult Dental Coverage - Basic Dental Care | Not Covered |
Adult Dental Coverage - Orthodontia | Not Covered |
Adult Dental Coverage - Major Dental Care | Not Covered |
Exclusions and Limitations | |
---|---|
More Included Benefits | Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Durable Medical Equipment Hospice Services Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Rehabilitative Speech Therapy Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Prescription Drugs Other Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
More Limited Benefits | Skilled Nursing Facility Hearing Aids Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy |
More Excluded Benefits | Acupuncture Bariatric Surgery Cosmetic Surgery Infertility Treatment Long Term Care Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Routine Foot Care Dental Care - Adult Abortion for Which Public Funding is Prohibited Nutritional Counseling Long-Term/Custodial Nursing Home Care |
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.
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.
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.
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.
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 Benefytt Technologies, Inc. family of companies.
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 Benefytt Technologies, Inc. family of companies.