Connect 4500 Silver Plan Details for 2021- HealthPocket

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Zip Code97229
Applicant10/23/1986 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameConnect 4500 Silver
Plan IDhhs-56707OR1380009
Plan Year2021
Insurance ProviderProvidence
Metal LevelSilver
Plan TypeEPO
Deductible$4,500
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$40 Copay
Specialist Visit$60 Copay
Laboratory Outpatient and Professional Services35% Coinsurance
X-rays and Diagnostic Imaging35% Coinsurance
Diagnostic Imaging such as MRIs, CT, and PET scans35% Coinsurance after deductible
Deductible - Family$9000 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs$65 Copay
Non-Preferred Brand Drugs50% Coinsurance after deductible
Specialty Drugs50% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://phppd.providence.org
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All Non-PCP Providers
Does this plan cover services outside plan service area?Yes - Emergency Care and Urgent Care
Does this plan cover services outside the country?Yes - Emergency Only

Hospital services

Emergency Room Services$250 Copay after deductible, 35% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)35% Coinsurance after deductible
Inpatient Physician and Surgical Services35% Coinsurance after deductible
Emergency Transportation or Ambulance Service35% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care35% Coinsurance after deductible
Delivery and all inpatient services for maternity care35% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$40 Copay
Mental/Behavioral Health Inpatient Services35% Coinsurance after deductible
Substance use disorder outpatient services$40 Copay
Substance use disorder inpatient services35% Coinsurance 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, Weight Loss Programs
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenCovered
Eye Glasses for ChildrenCovered
Routine Eye Exam for AdultsCovered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareCovered
Child Dental Coverage - Basic Dental CareCovered
Child Dental Coverage - OrthodontiaCovered
Child Dental Coverage - Major Dental CareCovered

Adult Dental Coverage

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

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Cosmetic Surgery
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
Dental Check-Up for Children
Routine Foot Care
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Formulary Tier 1
Formulary Tier 2
Formulary Tier 3
Formulary Tier 4
Formulary Tier 5
Formulary Tier 6
Formulary Tier 7
Providence Phone/Video and Virtual Visits - Primary Care Provider (PCP)
Providence Phone/Video and Virtual Visits - Specialist
More Limited BenefitsSkilled Nursing Facility
Acupuncture
Hearing Aids
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsBariatric Surgery
Infertility Treatment
Private-Duty Nursing
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
Treatment for Temporomandibular Joint Disorders
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
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  • Phone Number
    (503) 629-0237
  • Office Locations
    14223 Nw Spruceridge Ln
    Portland, OR 97229
14223 Nw Spruceridge Ln Portland OR, 97229
  • 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.

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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.