2018 Focus Network MA- Affordable HMO 25 Plan Details - HealthPocket

Focus Network MA- Affordable HMO 25

$655.62/mo

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Zip Code02128
Applicant8/17/1983 Male
Coverage Start8/18/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameFocus Network MA- Affordable HMO 25
Plan IDhhs-36046MA0710019
Insurance ProviderHarvard Pilgrim
Metal LevelPlatinum
Plan TypeHMO
Deductible$0
Out-of-Pocket Maximum$1,700
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit$40 Copay
Laboratory Outpatient and Professional Services$40 Copay
X-rays and Diagnostic Imaging$40 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans$125 Copay
Deductible - Family$0 per group
Out-of-Pocket Maximum - Family$3400 per group

Prescription drug coverage

Generic Drugs$5 Copay
Preferred Brand Drugs$40 Copay
Non-Preferred Brand Drugs$60 Copay
Specialty Drugs20.00% Coinsurance

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$125 Copay
Inpatient Hospital Services (e.g., Hospital Stay)$1000 Copay per Stay
Inpatient Physician and Surgical ServicesNo Charge
Emergency Transportation or Ambulance ServiceNo Charge

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care$1000 Copay

Mental Health

Mental/Behavioral Health Outpatient Services$25 Copay
Mental/Behavioral Health Inpatient Services$1000 Copay per Stay
Substance use disorder outpatient services$25 Copay
Substance use disorder inpatient services$1000 Copay per Stay

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 CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

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
Minor Dental Care - Child
Convenience Health Care Clinics
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
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
PremiumPlan NameDeductible
from $570
HNE Focus
$0.00Select
from $586
HNE Platinum A
$0.00Select
from $634
HNE Choice Plus
$0.00Select
from $634
Preferred Blue PPO Options Deductible II
$0.00Select
from $653
Focus Network - Affordable HMO 25
$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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