IHC Gold HMO Regional Preferred $15/$30

Individual Health Insurance (Obamacare)

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IHC Gold HMO Regional Preferred $15/$30

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Benefits & Coverage

Plan Name
IHC Gold HMO Regional Preferred $15/$30
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Gold
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$15 Copay
Specialist Visit
$30 Copay
Laboratory Outpatient and Professional Services
Not Applicable
X-rays and Diagnostic Imaging
$50 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
$100 Copay
Deductible - Family
$4000 per group
Out-of-Pocket Maximum - Family
$9300 per group

Prescription drug coverage

Generic Drugs
$7 Copay
Preferred Brand Drugs
50.00% Coinsurance
Non-Preferred Brand Drugs
50.00% Coinsurance
Specialty Drugs
50.00% Coinsurance

Access to doctors and hospitals

Provider directory URL
http://www.amerihealthnj.com/provider_finder
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Yes - All Specialist
Does this plan cover services outside plan service area?
Yes - Emergency Care is covered outside of the service area.
Does this plan cover services outside the country?
Not Covered

Hospital services

Emergency Room Services
$100 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care
Not Applicable
Delivery and all inpatient services for maternity care
40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$30 Copay
Mental/Behavioral Health Inpatient Services
40.00% Coinsurance after deductible
Substance use disorder outpatient services
$30 Copay
Substance use disorder inpatient services
40.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?
Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, 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
Included

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
Skilled Nursing Facility
Bariatric Surgery
Infertility Treatment
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
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 Anesthesia
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Mental Health Other
Second Opinion
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
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Autism Spectrum Disorders
Cancer Treatments
Domestic Violence Treatment
Infant Formulas
Off Label Prescription Drugs
Prescription Drugs Other
Sickle Cell Anemia
Third Opinion
Treatment of Hemophilia
Wilm's Tumor
More Limited Benefits
Hearing Aids
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

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Gold plan frequently asked questions (FAQ)

  • 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 Affordable Care Act health plans runs from November 1, 2015 to January 31, 2016. See our Open Enrollment article for more information.

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