2018 Minimum Coverage D EPO Plan Details - HealthPocket

Minimum Coverage D EPO

$238.16/mo

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Zip Code90011
Applicant8/15/1983 Male
Coverage Start8/16/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMinimum Coverage D EPO
Plan IDhhs-27603CA1500007
Insurance ProviderAnthem Blue Cross
Metal LevelCatastrophic
Plan TypeEPO
Deductible$7,350
Out-of-Pocket Maximum$7,350
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$0 Copay with deductible
Specialist Visit0.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services0.00% Coinsurance after deductible
X-rays and Diagnostic Imaging0.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans0.00% Coinsurance after deductible
Deductible - Family$14700 per group
Out-of-Pocket Maximum - Family$14700 per group

Prescription drug coverage

Generic Drugs0.00% Coinsurance after deductible
Preferred Brand Drugs0.00% Coinsurance after deductible
Non-Preferred Brand Drugs0.00% Coinsurance after deductible
Specialty Drugs0.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.anthem.com/health-insurance/provider-directory/searchcriteria
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - Standard Bluecard PPO Network
Does this plan cover services outside the country?No - Urgent/Emergency Coverage Only

Hospital services

Emergency Room Services0.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)0.00% Coinsurance after deductible
Inpatient Physician and Surgical Services0.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service0.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care0.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$0 Copay with deductible
Mental/Behavioral Health Inpatient Services0.00% Coinsurance after deductible
Substance use disorder outpatient services$0 Copay with deductible
Substance use disorder inpatient services0.00% 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
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

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

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Acupuncture
Bariatric Surgery
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
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Delivery and all Inpatient Services Professional Fee
Mental/Behavioral Health Inpatient Professional Fee
Outpatient Services Office Visit
Substance Use Disorder Inpatient Professional Fee
Emergency Room Professional Fee
More Limited BenefitsSkilled Nursing Facility
Home Health Care Services
Dental Check-Up for Children
More Excluded BenefitsCosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Chiropractic Care
Accidental Dental
Nutritional Counseling
PremiumPlan NameDeductible
from $248
Minimum Coverage PPO
$7,350.00Select
from $262
Minimum Coverage HMO
$7,350.00Select
from $309
Minimum Coverage HMO
$7,350.00Select
  • What is the Catastrophic Plan?

    Catastrophic health insurance is a type of medical coverage under the Affordable Care Act. This is a type of high-deductible health plan for people under 30 or those who qualify for a "hardship exemption."

  • How are Catastrophic 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. There is no actuarial value associated with catastrophic plans but other Obamacare metal plans pay a higher percentage of these costs.

  • How much does a Catastrophic Plan cost?

    The monthly premium for a Catastrophic 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 Catastrophic Plan premiums in your area.

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