2017 HealthyBlue PPO Gold $1,000 Plan Details - HealthPocket

HealthyBlue PPO Gold $1,000

$1,063.73/mo

Apply For This Plan

Zip Code23464
Applicant11/14/1983 Male
Coverage Start11/16/2018

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHealthyBlue PPO Gold $1,000
Plan IDhhs-40308VA0240005
Plan Year2017
Insurance ProviderCareFirst BlueCross BlueShield
Metal LevelGold
Plan TypePPO
Deductible$1,000
Out-of-Pocket Maximum$4,500
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or IllnessNo Charge
Specialist Visit$30 Copay, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Laboratory Outpatient and Professional Services$15 Copay, 0.00% Coinsurance. See plan brochure for when Copay is applicable.
X-rays and Diagnostic Imaging$65 Copay, 0.00% Coinsurance. See plan brochure for when Copay is applicable.
Diagnostic Imaging such as MRIs, CT, and PET scans$250 Copay, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family$2000 per group
Out-of-Pocket Maximum - Family$9000 per group

Prescription drug coverage

Generic DrugsNo Charge
Preferred Brand Drugs$50 Copay after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Non-Preferred Brand Drugs$70 Copay after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialty Drugs$150 Copay after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Access to doctors and hospitals

Provider directory URLhttps://member.carefirst.com/mos/#/fappublic/search/standard?sType=M&planName=BluePreferred
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 - All Covered Services
Does this plan cover services outside the country?Yes - All Covered Services

Hospital services

Emergency Room Services$300 Copay after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)$450 Copay per Day after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services$30 Copay after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Emergency Transportation or Ambulance Service$30 Copay after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care$450 Copay after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Mental Health

Mental/Behavioral Health Outpatient ServicesNo Charge
Mental/Behavioral Health Inpatient Services$450 Copay per Day after deductible, 0.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient servicesNo Charge
Substance use disorder inpatient services$450 Copay per Day after deductible, 0.00% Coinsurance after deductible. 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, Weight Loss Programs
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

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
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
Durable Medical Equipment
Hospice Services
Non-Emergency Care When Traveling Outside the U.S.
Dental Anesthesia
Diabetes Care Management
Mental Health Other
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
Blood and Blood Services
Bones/Joints
Clinical Trials
Early Intervention Services
Rape and Incest Coverage
More Limited BenefitsSkilled Nursing Facility
Private-Duty Nursing
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
PremiumPlan NameDeductible
from $489
KP VA Gold 1000/20/Dental
$1,000.00Select
from $538
OptimaFit Gold 1000 10% Direct RK M
$1,000.00Select
from $593
OptimaFit Gold 800 20% Direct
$800.00Select
from $598
KP VA Gold 1000/20/Dental
$1,000.00Select
from $658
OptimaFit Gold 1000 10% Direct RK
$1,000.00Select
  • 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 the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

Read More

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.

Close

Health Plans Found

 

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.