Empire EPO 600 Gold ST INN Pediatric Dental Dep 25 SNF

Individual Health Insurance (Obamacare)

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Empire EPO 600 Gold ST INN Pediatric Dental Dep 25 SNF

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Monthly Cost

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Benefits & Coverage

Plan Name
Empire EPO 600 Gold ST INN Pediatric Dental Dep 25 SNF
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Gold
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$25 Copay after deductible
Specialist Visit
$40 Copay after deductible
Laboratory Outpatient and Professional Services
$40 Copay after deductible
X-rays and Diagnostic Imaging
$40 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
$40 Copay after deductible
Deductible - Family
$1200 per group
Out-of-Pocket Maximum - Family
$8000 per group

Prescription drug coverage

Generic Drugs
$10 Copay
Preferred Brand Drugs
$35 Copay
Non-Preferred Brand Drugs
$70 Copay
Specialty Drugs
Not Applicable

Access to doctors and hospitals

Provider directory URL
http://www.empireblue.com
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?
No - TRAD/PAR network
Does this plan cover services outside the country?
No - Emergency Coverage Only

Hospital services

Emergency Room Services
$150 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
$1000 Copay per Stay after deductible
Inpatient Physician and Surgical Services
$100 Copay after deductible
Emergency Transportation or Ambulance Service
$150 Copay after deductible

Maternity

Prenatal and Postnatal Care
No Charge
Delivery and all inpatient services for maternity care
$1100 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$25 Copay after deductible
Mental/Behavioral Health Inpatient Services
$1000 Copay per Stay after deductible
Substance use disorder outpatient services
$25 Copay after deductible
Substance use disorder inpatient services
$1000 Copay per Stay after deductible

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
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
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
Bariatric Surgery
Infertility Treatment
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
Chiropractic Care
Applied Behavior Analysis Based Therapies
Cochlear Implants
Second Opinion
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Breast Reconstructive Surgery
Cardiac Rehabilitation
Prostate Cancer Screening
Assistive Communication Devices
Autologous Blood Banking
Gym Membership Reimbursement
Medical Supplies
Preadmission Testing
Design
Diabetic Equipment and Supplies
Family Planning Services
Sterilization Procedures for Men
More Limited Benefits
Skilled Nursing Facility
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Hospice Services
Dental Check-Up for Children
Inpatient Rehabilitation Services
Abortion for Which Public Funding is Prohibited
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Contact Lenses for Children
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Routine Foot Care
Nutritional Counseling

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is not eligible for a tax credit subsidy

Physician Directory

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Gold plan frequently asked questions (FAQ)

  • 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 Affordable Care Act health plans runs from November 1, 2015 to January 31, 2016. See our Open Enrollment article for more information.

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