Select HMO 2000 25/50 ER300 II Plan Details for 2021- HealthPocket

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Zip Code	02128 (edit)
Applicant	8/8/1987 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Select HMO 2000 25/50 ER300 II
Plan ID	hhs-41304MA0141762
Plan Year	2021
Insurance Provider	AllWays Health Partners
Metal Level	Silver
Plan Type	HMO
Deductible	$2,000
Out-of-Pocket Maximum	$8,700
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$25 Copay
Specialist Visit	$50 Copay
Laboratory Outpatient and Professional Services	$45 Copay after deductible
X-rays and Diagnostic Imaging	$75 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	$375 Copay after deductible
Deductible - Family	$4000 per group
Out-of-Pocket Maximum - Family	$17400 per group

Prescription drug coverage
Generic Drugs	$25 Copay
Preferred Brand Drugs	$50 Copay
Non-Preferred Brand Drugs	$75 Copay after deductible
Specialty Drugs	$75 Copay after deductible

Access to doctors and hospitals
Provider directory URL	http://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	$300 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$750 Copay per Stay after deductible
Inpatient Physician and Surgical Services	Not Applicable
Emergency Transportation or Ambulance Service	Not Applicable

Maternity
Prenatal and Postnatal Care	Not Applicable
Delivery and all inpatient services for maternity care	$750 Copay after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$25 Copay
Mental/Behavioral Health Inpatient Services	$750 Copay per Stay after deductible
Substance use disorder outpatient services	$25 Copay
Substance use disorder inpatient services	$750 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?	Covered

Vision Coverage
Routine Eye Exam for Children	Covered
Eye Glasses for Children	Covered
Routine Eye Exam for Adults	Covered

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Covered
Child Dental Coverage - Basic Dental Care	Covered
Child Dental Coverage - Orthodontia	Covered
Child Dental Coverage - Major Dental Care	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) 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 Benefits	Preventive 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 Benefits	Acupuncture Cosmetic Surgery Private-Duty Nursing Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $370	Standard Low Silver: Community Care Connector Low Silver HSA	$2,000.00	Select
from $373	Standard Silver: Community Care Connector High Silver	$2,000.00	Select
from $428	Premier Silver Saver 2000	$2,000.00	Select
from $454	Select Advantage HMO 2000	$2,000.00	Select
from $455	Premier Silver 2000	$2,000.00	Select

Last Name

Location/Distance

Please select the correct zip

Jackie, Fantes

Loretta, Chou

Pengwynne, Blevins

Charles, Williams

Lisa, Scarfo

Jonathan, Hatoun

Kristen, Pompey

East Boston Behavioral Health And Medicine Llc

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Madison, Kronheim

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Gina, Campanella

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Nairobi, Oller-laureano

Jacklyn, Giampa

Mary, Gallagher

Meghan, Riedy

Victoria, Shopland

Jessica, Maclean

Nairoby, Nunez

Julia, Bird

Alison, Carr

Adrianna, D'aurora

Jackie Fantes, MD

Phone Number
(617) 569-5800
Office Locations
10 Gove St
East Boston, MA 02128

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.

HealthPocket.com is a free information source. 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. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.

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Select HMO 2000 25/50 ER300 II

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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Select HMO 2000 25/50 ER300 II

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

Related Articles

Related Searches

Silver plan frequently asked questions (FAQ)

What Is the Silver Plan?

How are Silver Plans different than other Obamacare health plans?

How much does a Silver Plan cost?

When Can I Enroll in a Silver Plan?

Apply For This Plan

Health Plans Found

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