2018 Best Buy HSA HMO 2000 with Cost Share - Flex Plan Details - HealthPocket

Best Buy HSA HMO 2000 with Cost Share - Flex

$470.49/mo

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Zip Code02128
Applicant8/19/1983 Male
Coverage Start8/20/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBest Buy HSA HMO 2000 with Cost Share - Flex
Plan IDhhs-36046MA0690095
Insurance ProviderHarvard Pilgrim
Metal LevelSilver
Plan TypeHMO
Deductible$2,000
Out-of-Pocket Maximum$6,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay after deductible
Specialist Visit$55 Copay after deductible
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic Imaging$55 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$200 Copay after deductible
Deductible - Family$5000 per group
Out-of-Pocket Maximum - Family$12000 per group

Prescription drug coverage

Generic Drugs$5 Copay after deductible
Preferred Brand Drugs$80 Copay after deductible
Non-Preferred Brand Drugs$110 Copay after deductible
Specialty Drugs20.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.providerlookuponline.com/Harvardpilgrim/po7/Search.aspx
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers
Does this plan cover services outside plan service area?Not Covered
Does this plan cover services outside the country?Not Covered

Hospital services

Emergency Room Services$400 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$500 Copay per Stay after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Emergency Transportation or Ambulance ServiceNo Charge after deductible

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care$500 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$35 Copay after deductible
Mental/Behavioral Health Inpatient Services$500 Copay per Stay after deductible
Substance use disorder outpatient services$35 Copay after deductible
Substance use disorder inpatient services$500 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, 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 AdultsIncluded

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
Acupuncture
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
Home Health Care Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Routine Foot Care
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Well Baby Visits and Care
Bone Marrow Transplants for Treatment of Breast Cancer
Cardiac Rehabilitation
Clinical Trials
Congenital Anomaly, including Cleft Lip/Palate
Contraceptive Services
Early Intervention Services
Hormone Replacement Therapy (HRT)
Human Leukocyte Antigen Testing
Hypodermic Syringes or Needles
Nutrition/Formulas
Off Label Prescription Drugs
Childbirth Classes
Fitness Club Reimbursement
Low Protein Foods
Convenience Health Care Clinics
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Inpatient Rehabilitation Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
Treatment for Temporomandibular Joint Disorders
Wigs
More Excluded BenefitsCosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Non-Emergency Care When Traveling Outside the U.S.
PremiumPlan NameDeductible
from $345
HNE Wise 2000/20% HDHP
$2,000.00Select
from $365
HNE Silver A
$2,000.00Select
from $380
HMO Blue Select Saver $2,000
$2,000.00Select
from $391
HMO Blue Select $2,000 Deductible with Copayment
$2,000.00Select
from $399
HNE Wise Max HDHP
$2,000.00Select
  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver 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 Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver 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 Silver Plan premiums in your area.

  • When Can I Enroll in a Silver 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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