Blue Focus Gold POS 207

Individual Health Insurance (Obamacare)

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Blue Focus Gold POS 207

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Monthly Cost

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Benefits & Coverage

Plan Name
Blue Focus Gold POS 207
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Metal Level
Gold
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
20.00% Coinsurance
Specialist Visit
40.00% Coinsurance
Laboratory Outpatient and Professional Services
40.00% Coinsurance
X-rays and Diagnostic Imaging
40.00% Coinsurance
Diagnostic Imaging such as MRIs, CT, and PET scans
40.00% Coinsurance
Deductible - Family
$0 per group
Out-of-Pocket Maximum - Family
$14700 per group

Prescription drug coverage

Generic Drugs
10.00% Coinsurance
Preferred Brand Drugs
30.00% Coinsurance
Non-Preferred Brand Drugs
35.00% Coinsurance
Specialty Drugs
45.00% Coinsurance

Access to doctors and hospitals

Provider directory URL
https://www.bcbsmt.com/_layouts/BCBSMTPortal/FindProvider/ProviderSearchResults.aspx
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 - When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are Participating Providers) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (Host Blue). In some instances, you may obtain care from Non-Participating Providers.
Does this plan cover services outside the country?
Yes - This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Hospital services

Emergency Room Services
$1000 Copay with deductible, 40.00% Coinsurance. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)
$850 Copay per Stay with deductible, 40.00% Coinsurance. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services
40.00% Coinsurance
Emergency Transportation or Ambulance Service
40.00% Coinsurance

Maternity

Prenatal and Postnatal Care
20.00% Coinsurance
Delivery and all inpatient services for maternity care
$850 Copay with deductible, 40.00% Coinsurance. See plan brochure for when Copay is applicable.

Mental Health

Mental/Behavioral Health Outpatient Services
20.00% Coinsurance
Mental/Behavioral Health Inpatient Services
$850 Copay per Stay with deductible, 40.00% Coinsurance. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services
20.00% Coinsurance
Substance use disorder inpatient services
$850 Copay per Stay with deductible, 40.00% Coinsurance. See plan brochure for when Copay is applicable.

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?
Not Covered

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

More Included Benefits
Other Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Cosmetic Surgery
Infertility Treatment
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
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Well Baby Visits and Care
Prescription Drugs Other
More Limited Benefits
Skilled Nursing Facility
Acupuncture
Home Health Care Services
Chiropractic Care
More Excluded Benefits
Bariatric Surgery
Hearing Aids
Long-Term/Custodial Nursing Home Care
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

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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