Insurance Type | ACA (Obamacare) |
Plan Name | Blue Option Silver 6100 HD |
Plan ID | hhs-49532SC0380115 |
Plan Year | 2021 |
Insurance Provider | BlueChoice HealthPlan |
Metal Level | Silver |
Plan Type | EPO |
Deductible | $6,100 |
Out-of-Pocket Maximum | $6,100 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | No Charge after deductible |
Specialist Visit | No Charge after deductible |
Laboratory Outpatient and Professional Services | No Charge after deductible |
X-rays and Diagnostic Imaging | No Charge after deductible |
Diagnostic Imaging such as MRIs, CT, and PET scans | No Charge after deductible |
Deductible - Family | $12200 per group |
Out-of-Pocket Maximum - Family | $12200 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | No Charge after deductible |
Preferred Brand Drugs | No Charge after deductible |
Non-Preferred Brand Drugs | No Charge after deductible |
Specialty Drugs | No Charge after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | http://www.bluechoicesc.com/doctorhospitalfinder.aspx |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Not Covered |
Does this plan cover services outside plan service area? | Yes - Emergency care and urgent care obtained outside the geographic areas we serve. Any other services will not be covered when processed through any Inter-Plan Programs arrangements. These "other services" must be provided or Authorized by your primary care physician ("PCP"). |
Does this plan cover services outside the country? | Yes - Emergency care and urgent care obtained outside the geographic areas we serve. Any other services will not be covered when processed through any Inter-Plan Programs arrangements. These "other services" must be provided or Authorized by your primary care physician ("PCP"). |
Hospital services | |
---|---|
Emergency Room Services | No Charge after deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | No Charge after deductible |
Inpatient Physician and Surgical Services | No Charge after deductible |
Emergency Transportation or Ambulance Service | No Charge after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | No Charge after deductible |
Delivery and all inpatient services for maternity care | No Charge after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | No Charge after deductible |
Mental/Behavioral Health Inpatient Services | No Charge after deductible |
Substance use disorder outpatient services | No Charge after deductible |
Substance use disorder inpatient services | No Charge after deductible |
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? | Included |
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 | |
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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 Chiropractic Care Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Radiation Reconstructive Surgery Transplant Well Baby Visits and Care Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Doctor's Care Freestanding Ambulatory Surgery Center |
More Limited Benefits | Skilled Nursing Facility Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Hospice Services Prosthetic Devices Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy |
More Excluded Benefits | Acupuncture Bariatric Surgery Cosmetic Surgery Hearing Aids Infertility Treatment Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Treatment for Temporomandibular Joint Disorders 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.
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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.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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