Silver 70 Off Exchange PPO

Individual Health Insurance (Obamacare)

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Silver 70 Off Exchange PPO

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Monthly Cost

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Benefits & Coverage

Plan Name
Silver 70 Off Exchange PPO
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Silver
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$35 Copay
Specialist Visit
$75 Copay
Laboratory Outpatient and Professional Services
$35 Copay
X-rays and Diagnostic Imaging
$75 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
$300 Copay
Deductible - Family
$5000 per group
Out-of-Pocket Maximum - Family
$14000 per group

Prescription drug coverage

Generic Drugs
$15 Copay after deductible
Preferred Brand Drugs
$55 Copay after deductible
Non-Preferred Brand Drugs
$80 Copay after deductible
Specialty Drugs
20.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URL
https://blueshieldcaplans.com/compareplans/l-select.php
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Not Covered
Does this plan cover services outside plan service area?
Yes - Mirror in-state administration of benefit
Does this plan cover services outside the country?
Not Covered

Hospital services

Emergency Room Services
$350 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
20.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
$255 Copay after deductible

Maternity

Prenatal and Postnatal Care
No Charge
Delivery and all inpatient services for maternity care
20.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$35 Copay
Mental/Behavioral Health Inpatient Services
20.00% Coinsurance after deductible
Substance use disorder outpatient services
$35 Copay
Substance use disorder inpatient services
20.00% Coinsurance after deductible

Medical Management Programs

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
Not Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Included
Child Dental Coverage - Basic Dental Care
Included
Child Dental Coverage - Orthodontia
Included
Child Dental Coverage - Major Dental Care
Included

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
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
Dental Check-Up for Children
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 Benefits
Skilled Nursing Facility
Home Health Care Services
More Excluded Benefits
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Chiropractic Care
Accidental Dental
Nutritional Counseling

What To Know

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

Physician Directory

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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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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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