Dean Classic 3000X

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
Dean Classic 3000X
Plan Year
2015
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
10% Coinsurance after deductible
Specialist Visit
10% Coinsurance after deductible
Laboratory Outpatient and Professional Services
10% Coinsurance after deductible
X-rays and Diagnostic Imaging
10% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
10% Coinsurance after deductible
Deductible - Family
$6000
Out-of-Pocket Maximum - Family
$13200

Prescription drug coverage

Generic Drugs
$10 Copay
Preferred Brand Drugs
$40 Copay
Non-Preferred Brand Drugs
50% Coinsurance
Specialty Drugs
50% Coinsurance

Access to doctors and hospitals

Provider directory URL
http://www.deancare.com/doctors
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 only
Does this plan cover services outside the country?
Yes - Emergency only

Hospital services

Emergency Room Services
$200 Copay before deductible, 10% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)
$0 Copay per Day, 10% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services
10% Coinsurance after deductible
Emergency Transportation or Ambulance Service
10% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care
10% Coinsurance after deductible
Delivery and all inpatient services for maternity care
10% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
10% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
10% Coinsurance after deductible
Substance use disorder outpatient services
10% Coinsurance after deductible
Substance use disorder inpatient services
10% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?
Asthma, Heart Disease, Diabetes, 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
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)
Preventive Care/Screening/Immunization
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
Habilitation Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Dental Anesthesia
Diabetes Care Management
Mental Health Other
Accidental Dental
Chemotherapy
Allergy Testing
Dialysis
Diabetes Education
Laboratory Outpatient and Professional Services
Radiation
Nutritional Counseling
Infusion Therapy
Prosthetic Devices
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Clinical Trials
Newborn Services Other
Prescription Drugs Other
More Limited Benefits
Skilled Nursing Facility
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits
Acupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.
Abortion for Which Public Funding is Prohibited

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is eligible for a tax credit subsidy

Physician Directory

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