HMO Blue Select $2,000 Deductible with Copayment
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | HMO Blue Select $2,000 Deductible with Copayment |
| Plan ID | hhs-42690MA1390009 |
| Plan Year | 2019 |
| Insurance Provider | Blue Cross Blue Shield of Massachusetts |
| Metal Level | Silver |
| Plan Type | HMO |
| Deductible | $2,000 |
| Out-of-Pocket Maximum | $7,500 |
| Plan Highlights |
Costs for Medical Care | |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $25 Copay |
| Specialist Visit | $45 Copay |
| Laboratory Outpatient and Professional Services | $55 Copay after deductible |
| X-rays and Diagnostic Imaging | $55 Copay after deductible |
| Diagnostic Imaging such as MRIs, CT, and PET scans | $150 Copay after deductible |
| Deductible - Family | $4000 per group |
| Out-of-Pocket Maximum - Family | $15000 per group |
Prescription drug coverage | |
|---|---|
| Generic Drugs | $50 Copay |
| Preferred Brand Drugs | $175 Copay |
| Non-Preferred Brand Drugs | $250 Copay |
| Specialty Drugs | $175 Copay |
Access to doctors and hospitals | |
|---|---|
| Provider directory URL | http://www.bluecrossma.com/wps/portal/members/using-my-plan/doctors-hospitals/findadoctor/ |
| Does this plan have access to a national provider network? | No |
| Is a referral required to see a Specialist? | Yes - All specialists except OB/GYN providers |
| Does this plan cover services outside plan service area? | Yes - Emergency and Urgent Care Services only |
| Does this plan cover services outside the country? | Yes - Emergency and Urgent Care Services only |
Hospital services | |
|---|---|
| Emergency Room Services | $250 Copay after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | $500 Copay per Stay after deductible |
| Inpatient Physician and Surgical Services | Not Applicable |
| Emergency Transportation or Ambulance Service | Not Applicable |
Maternity | |
|---|---|
| Prenatal and Postnatal Care | Not Applicable |
| Delivery and all inpatient services for maternity care | $500 Copay after deductible |
Mental Health | |
|---|---|
| Mental/Behavioral Health Outpatient Services | $25 Copay |
| Mental/Behavioral Health Inpatient Services | $500 Copay per Stay after deductible |
| Substance use disorder outpatient services | $25 Copay |
| Substance use disorder inpatient services | $500 Copay per Stay after deductible |
Medical Management Programs | |
|---|---|
| Does this plan offer disease managment programs? | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, 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 | 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) Bariatric 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 Home Health Care Services Durable Medical Equipment Hospice Services Chiropractic Care Diabetes Care Management Abortion for Which Public Funding is Prohibited Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Rehabilitative Speech Therapy Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Bone Marrow Transplants for Treatment of Breast Cancer Cardiac Rehabilitation Clinical Trials Congenital Anomaly, including Cleft Lip/Palate Contraceptive Services Early Intervention Services Hormone Replacement Therapy (HRT) Human Leukocyte Antigen Testing Hypodermic Syringes or Needles Nutrition/Formulas Off Label Prescription Drugs |
| More Limited Benefits | Preventive Care/Screening/Immunization Skilled Nursing Facility Hearing Aids Weight Loss Programs Outpatient Rehabilitation Services Habilitation Services Rehabilitative Occupational and Rehabilitative Physical Therapy |
| More Excluded Benefits | Acupuncture Cosmetic Surgery Long-Term/Custodial Nursing Home Care Private-Duty Nursing Dental Check-Up for Children Routine Foot Care Accidental Dental |
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Silver plan frequently asked questions (FAQ)
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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