HAP Personal Alliance 5000 HMO Genesys Choice
$254.14/mo
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | HAP Personal Alliance 5000 HMO Genesys Choice |
| Plan ID | hhs-37651MI0300006 |
| Insurance Provider | Health Alliance Plan |
| Metal Level | Expanded Bronze |
| Plan Type | HMO |
| Deductible | $5,000 |
| Out-of-Pocket Maximum | $7,350 |
| 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 |
| More Limited Benefits | Skilled Nursing Facility 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 |
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