2018 Community Delta HSA HMO Plan Details - HealthPocket

Community Delta HSA HMO

$448.99/mo

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Zip Code04401
Applicant8/18/1983 Male
Coverage Start8/19/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameCommunity Delta HSA HMO
Plan IDhhs-33653ME0570002
Insurance ProviderMaine Community Health Options
Metal LevelSilver
Plan TypeHMO
Deductible$2,900
Out-of-Pocket Maximum$6,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness15.00% Coinsurance after deductible
Specialist Visit15.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services15.00% Coinsurance after deductible
X-rays and Diagnostic Imaging15.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans15.00% Coinsurance after deductible
Deductible - Family$5800 per group
Out-of-Pocket Maximum - Family$13100 per group

Prescription drug coverage

Generic Drugs15.00% Coinsurance after deductible
Preferred Brand Drugs15.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.healthoptions.org/search-provider
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 - Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis.
Does this plan cover services outside the country?Not Covered

Hospital services

Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)15.00% Coinsurance after deductible
Inpatient Physician and Surgical Services15.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care15.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care15.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services15.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services15.00% Coinsurance after deductible
Substance use disorder outpatient services15.00% Coinsurance after deductible
Substance use disorder inpatient services15.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy
Does this plan offer a wellness program?Included

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 CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

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
Home Health Care Services
Habilitation Services
Durable Medical Equipment
Hospice Services
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
Well Baby Visits and Care
Autism Spectrum Disorders
Blood and Blood Services
Clinical Trials
Nutrition/Formulas
Massage Therapy
Inhalation Therapy
Sleep Studies
Diabetic Retinopathy Screenings
Gender Reassignment Surgery
Mental/Behavioral Health Partial Hospitalization Services
Orthotic Devices
Substance Abuse Disorder Partial Hospitalization Services
Tobacco/Smoking Cessation
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Outpatient Rehabilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Cardiac Rehabilitation
Early Intervention Services
Human Leukocyte Antigen Testing
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Treatment for Temporomandibular Joint Disorders
PremiumPlan NameDeductible
from $401
Maine's Choice Sebago Silver HMO
$3,000.00Select
from $503
Anthem Maine Silver POS 3000
$3,000.00Select
from $510
Anthem Maine Silver POS 2900 for HSA
$2,900.00Select
from $555
Maine's Choice Sebago Silver HMO
$3,000.00Select
  • 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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