Benefits & Coverage
Plan Name
HAP Personal Alliance 5000 HMO Genesys Choice
Plan ID
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Expanded Bronze
Plan Type
Deductible
Out-of-Pocket Maximum
Plan Highlights
Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness
$30 Copay, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit
40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services
40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
40.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
40.00% Coinsurance after deductible
Deductible - Family
$10000 per group
Out-of-Pocket Maximum - Family
$14700 per group
Prescription drug coverage
Generic Drugs
$7 Copay
Preferred Brand Drugs
50.00% Coinsurance after deductible
Non-Preferred Brand Drugs
50.00% Coinsurance after deductible
Specialty Drugs
50.00% Coinsurance after deductible
Access to doctors and hospitals
Provider directory URL
http://www.choosehap.org/find-doctor
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Yes - Varies based on service and provider network; visit hap.org for details.
Does this plan cover services outside plan service area?
No - Urgent and emergency services only
Does this plan cover services outside the country?
No - Urgent and emergency services only
Hospital services
Emergency Room Services
40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
40.00% Coinsurance after deductible
Maternity
Prenatal and Postnatal Care
40.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care
40.00% Coinsurance after deductible
Mental Health
Mental/Behavioral Health Outpatient Services
$30 Copay
Mental/Behavioral Health Inpatient Services
40.00% Coinsurance after deductible
Substance use disorder outpatient services
$30 Copay
Substance use disorder inpatient services
40.00% Coinsurance 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, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?
Included
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
Infertility Treatment
Weight Loss Programs
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
Home Health Care Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
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
Telehealth Services
Preventive Care/Screening/Immunization
Infertility Treatment
Weight Loss Programs
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
Home Health Care Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
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
Telehealth Services
More Limited Benefits
Skilled Nursing Facility
Bariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Bariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Hearing Aids
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Non-Emergency Care When Traveling Outside the U.S.
Abortion for Which Public Funding is Prohibited
Cosmetic Surgery
Hearing Aids
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
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.
Physician Directory
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