Dean Copay Plus 3500X

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
Dean Copay Plus 3500X
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
$30 Copay
Specialist Visit
$60 Copay
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
$100 Copay
Deductible - Family
$7000
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
$30 Copay
Delivery and all inpatient services for maternity care
10% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$30 Copay
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
Prescription Drugs Other
Newborn Services Other
Clinical Trials
Well Baby Visits and Care
Treatment for Temporomandibular Joint Disorders
Transplant
Reconstructive Surgery
Prosthetic Devices
Infusion Therapy
Nutritional Counseling
Radiation
Laboratory Outpatient and Professional Services
Diabetes Education
Dialysis
Allergy Testing
Chemotherapy
Accidental Dental
Mental Health Other
Diabetes Care Management
Dental Anesthesia
Chiropractic Care
Hospice Services
Durable Medical Equipment
Habilitation Services
Inpatient Physician and Surgical Services
Urgent Care Centers or Facilities
Outpatient Surgery Physician/Surgical Services
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Other Practitioner Office Visit (Nurse, Physician Assistant)
More Limited Benefits
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Outpatient Rehabilitation Services
Home Health Care Services
Hearing Aids
Skilled Nursing Facility
More Excluded Benefits
Abortion for Which Public Funding is Prohibited
Non-Emergency Care When Traveling Outside the U.S.
Routine Foot Care
Dental Check-Up for Children
Weight Loss Programs
Private-Duty Nursing
Long-Term/Custodial Nursing Home Care
Infertility Treatment
Cosmetic Surgery
Bariatric Surgery
Acupuncture

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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