2018 Maine's Choice HSA HMO 5000 Plan Details - HealthPocket

Maine's Choice HSA HMO 5000

$313.01/mo

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Zip Code04401
Applicant8/14/1983 Male
Coverage Start8/15/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMaine's Choice HSA HMO 5000
Plan IDqhp-96667ME0260018
Insurance ProviderHarvard Pilgrim
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,000
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$10000
Out-of-Pocket Maximum - Family$13100

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs30% Coinsurance after deductible
Non-Preferred Brand Drugs50% Coinsurance after deductible
Specialty Drugs50% 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 $28
Everest 5000/20/9000
$5,000.00Select
from $28
Everest 5000/20/8000
$5,000.00Select
from $29
Everest 5000/20/7000
$5,000.00Select
from $57
National General 5000/50/8750/250000
$5,000.00Select
from $73
National General 5000/20/7000/1000000
$5,000.00Select

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