2018 Gym Access IND Triple Option Platinum 82 Plan Details - HealthPocket

Gym Access IND Triple Option Platinum 82

$620.82/mo

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Zip Code33186
Applicant8/14/1983 Male
Coverage Start8/15/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameGym Access IND Triple Option Platinum 82
Plan IDhhs-56503FL2690002
Insurance ProviderFlorida Healthcare Plan
Metal LevelPlatinum
Plan TypePOS
Deductible$0
Out-of-Pocket Maximum$3,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$20 Copay
Specialist Visit$35 Copay
Laboratory Outpatient and Professional ServicesNot Applicable
X-rays and Diagnostic Imaging$10 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans$50 Copay
Deductible - Family$0 per group
Out-of-Pocket Maximum - Family$6000 per group

Prescription drug coverage

Generic Drugs$10 Copay
Preferred Brand Drugs$30 Copay
Non-Preferred Brand Drugs$55 Copay
Specialty Drugs50.00% Coinsurance

Access to doctors and hospitals

Provider directory URLhttp://www.fhcp.com/physician.do
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 - Emergency and Urgent Care only, unless pre-authorized by Issuer.
Does this plan cover services outside the country?Yes - Emergency and Urgent Care Only

Hospital services

Emergency Room Services$100 Copay
Inpatient Hospital Services (e.g., Hospital Stay)$250 Copay per Day
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance Service$100 Copay

Maternity

Prenatal and Postnatal Care$35 Copay
Delivery and all inpatient services for maternity care$250 Copay

Mental Health

Mental/Behavioral Health Outpatient Services$35 Copay
Mental/Behavioral Health Inpatient Services$250 Copay per Day
Substance use disorder outpatient services$35 Copay
Substance use disorder inpatient services$250 Copay per Day

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs
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
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
Dental Anesthesia
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
Osteoporosis
Gym Access
More Limited BenefitsSkilled Nursing Facility
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Diabetes Care Management
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Off Label Prescription Drugs
More Excluded BenefitsAcupuncture
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
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $1,235
BlueOptions Platinum 1424
$0.00Select
from $408
Gym Access IND Gold HMO BC 5651
$0.00Select
from $438
BlueSelect Gold 1535
$0.00Select
from $449
Gym Access IND Gold POS BC 5651
$0.00Select
from $453
Gym Access IND Platinum HMO 4000
$0.00Select
  • 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.

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