BlueOptions Platinum 1424
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | BlueOptions Platinum 1424 |
| Plan ID | hhs-16842FL0070110 |
| Plan Year | 2018 |
| Insurance Provider | Blue Cross Blue Shield of Florida |
| Metal Level | Platinum |
| Plan Type | EPO |
| Deductible | $0 |
| Out-of-Pocket Maximum | $2,000 |
| Plan Highlights |
Costs for Medical Care | |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $10 Copay |
| Specialist Visit | $20 Copay |
| Laboratory Outpatient and Professional Services | Not Applicable |
| X-rays and Diagnostic Imaging | $75 Copay |
| Diagnostic Imaging such as MRIs, CT, and PET scans | $150 Copay |
| Deductible - Family | $0 per group |
| Out-of-Pocket Maximum - Family | $4000 per group |
Prescription drug coverage | |
|---|---|
| Generic Drugs | $10 Copay |
| Preferred Brand Drugs | $40 Copay |
| Non-Preferred Brand Drugs | 30.00% Coinsurance |
| Specialty Drugs | 50.00% Coinsurance |
Access to doctors and hospitals | |
|---|---|
| Provider directory URL | http://myportal.bcbsfl.com/wps/portal/opd |
| 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 - Covered services as outlined in the member contract. |
| Does this plan cover services outside the country? | Yes - Covered services as outlined in the member contract. |
Hospital services | |
|---|---|
| Emergency Room Services | $75 Copay |
| Inpatient Hospital Services (e.g., Hospital Stay) | $350 Copay per Day |
| Inpatient Physician and Surgical Services | Not Applicable |
| Emergency Transportation or Ambulance Service | $350 Copay |
Maternity | |
|---|---|
| Prenatal and Postnatal Care | $20 Copay |
| Delivery and all inpatient services for maternity care | $350 Copay |
Mental Health | |
|---|---|
| Mental/Behavioral Health Outpatient Services | $20 Copay |
| Mental/Behavioral Health Inpatient Services | $350 Copay per Day |
| Substance use disorder outpatient services | $20 Copay |
| Substance use disorder inpatient services | $350 Copay per Day |
Medical Management Programs | |
|---|---|
| Does this plan offer disease managment programs? | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, 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 | Not Covered |
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 Durable Medical Equipment Hospice Services Routine Foot Care Dental Anesthesia Diabetes Care Management 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 Bone Marrow Transplant Congenital Anomaly, including Cleft Lip/Palate Nutrition/Formulas Off Label Prescription Drugs Osteoporosis |
| More Limited Benefits | Skilled Nursing Facility Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy |
| More Excluded Benefits | Acupuncture Bariatric Surgery Cosmetic Surgery Hearing Aids Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Abortion for Which Public Funding is Prohibited |
Platinum plan frequently asked questions (FAQ)
What is the Platinum Plan?
ObamaCare’s Platinum Plan is a type of Metal Plan on the Health Insurance Marketplace. Platinum Plans qualify for Tax Credits and have the highest premiums. A Platinum Plan is designed to incur the lowest out-of-pocket expenses for enrollees. A typical platinum plan enrollee pays approximately 10% of the costs of covered healthcare services with the plan paying the remainder. In comparison, a typical Bronze Plan enrollee pays 40% of covered medical expenses.
How are Platinum 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 Platinum Plan pays 90% of covered medical costs for a typical enrollee while the other Obamacare health plans pay a lower percentage of these costs.
How much does a Platinum Plan cost?
The monthly premium for a Platinum 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 Platinum Plan premiums in your area.
When Can I Enroll in a Platinum 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.
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.
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