Harmony by Medica Gold Share Plan Details for 2020- HealthPocket

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Zip Code73160
Applicant7/10/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHarmony by Medica Gold Share
Plan IDqhp-21333OK0010025
Plan Year2020
Insurance ProviderMedica
Metal LevelGold
Plan TypePPO
Deductible$400
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness35% Coinsurance after deductible
Specialist Visit35% Coinsurance after deductible
Laboratory Outpatient and Professional Services35.00% Coinsurance after deductible
X-rays and Diagnostic Imaging35.00% Coinsurance after deductible
Deductible - Family$1200
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs$70 Copay
Non-Preferred Brand Drugs50% Coinsurance after deductible
Specialty Drugs$500 Copay

Access to doctors and hospitals

Provider directory URLhttps://www.medica.com/harmonyproviders

Hospital services

Emergency Room Services35% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)35% Coinsurance after deductible
Inpatient Physician and Surgical Services35% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care35.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services35.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services35.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for Children35.00% Coinsurance after deductible
Eye Glasses for Children35.00% Coinsurance after deductible

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Private-Duty Nursing
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Nutritional Counseling
Reconstructive Surgery
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Bariatric Surgery
Cosmetic Surgery
Routine Foot Care
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
Treatment for Temporomandibular Joint Disorders
PremiumPlan NameDeductible
from $537
Harmony by Medica Gold Share
$400.00Select
from $539
Blue Preferred Gold PPO 205
$500.00Select
from $620
Blue Preferred Gold PPO? 205
$500.00Select
from $779
Medica Quest Gold Share
$400.00Select
from $908
Medica Quest Gold Share
$400.00Select
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  • Phone Number
    (405) 794-6691
  • Office Locations
    3001 S Telephone Rd
    Moore, OK 73160
3001 S Telephone Rd Moore OK, 73160
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold 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 Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold 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 your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold 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, 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.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).