2018 Best Buy HSA HMO 5400 Plan Details - HealthPocket

Best Buy HSA HMO 5400


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Zip Code04401
Applicant10/22/1983 Male
Coverage Start10/23/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBest Buy HSA HMO 5400
Plan IDqhp-96667ME0240024
Plan Year2018
Insurance ProviderHarvard Pilgrim
Metal LevelExpanded Bronze
Plan TypeHMO
Out-of-Pocket Maximum$6,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness30% Coinsurance after deductible
Specialist Visit30% Coinsurance after deductible
Deductible - Family$10800
Out-of-Pocket Maximum - Family$13100

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs40% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs40% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLComing Soon

Hospital services

Emergency Room Services30% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30% Coinsurance after deductible
Inpatient Physician and Surgical Services30% Coinsurance after deductible
PremiumPlan NameDeductible
from $263
Community Focus PPO
from $266
Community Reliant HSA PPO
from $290
Community Align PPO
from $369
Community Focus PPO
from $372
Community Reliant HSA PPO

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