Standard Platinum

Individual Health Insurance (Obamacare)

Don't overpay for your Health Insurance.

Call Toll Free (800) 984-8015

Standard Platinum

select spinner

Monthly Cost

from$756

Select
SAVE THIS PLAN

Benefits & Coverage

Plan Name
Standard Platinum
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Platinum
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$20 Copay
Specialist Visit
$40 Copay
Laboratory Outpatient and Professional Services
No Charge
X-rays and Diagnostic Imaging
No Charge
Diagnostic Imaging such as MRIs, CT, and PET scans
$150 Copay
Deductible - Family
$0 per group
Out-of-Pocket Maximum - Family
$6000 per group

Prescription drug coverage

Generic Drugs
$10 Copay
Preferred Brand Drugs
$25 Copay
Non-Preferred Brand Drugs
$50 Copay
Specialty Drugs
$50 Copay

Access to doctors and hospitals

Provider directory URL
http://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
$150 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
$500 Copay per Stay
Inpatient Physician and Surgical Services
No Charge
Emergency Transportation or Ambulance Service
No Charge

Maternity

Prenatal and Postnatal Care
No Charge
Delivery and all inpatient services for maternity care
$500 Copay

Mental Health

Mental/Behavioral Health Outpatient Services
$20 Copay
Mental/Behavioral Health Inpatient Services
$500 Copay per Stay
Substance use disorder outpatient services
$20 Copay
Substance use disorder inpatient services
$500 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 Children
Included
Eye Glasses for Children
Included
Routine Eye Exam for Adults
Included

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Included
Child Dental Coverage - Basic Dental Care
Included
Child Dental Coverage - Orthodontia
Included
Child Dental Coverage - Major Dental Care
Included

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
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 Benefits
Skilled Nursing Facility
Acupuncture
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 Benefits
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

Enter your ZIP Code to see physicians that accepts Standard Platinum plan in your area.

Similar Plans

Enter your ZIP Code to see Similar Plans to Standard Platinum plan in your area.

Related Articles

Related Searches

Platinum plan frequently asked questions (FAQ)

  • 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.

Read More

 

 

Speak with a licensed agent

(800) 984-8015

(800) 984-8015

LEARN MORE​ 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

{"globalPhoneNumber":"8009848015","helpInfo":{"leadCopy":"Speak with a licensed agent","phone":"8009848015","analyticsInfo":{"pageType":"details","productLine":"ifp","phone":"8009848015"}},"bannerData":{"hbi":{"link":"Need extra coverage?","href":"https://www.agilehealthinsurance.com/health-benefit-insurance-quotes?xsell=1&utm_source=healthpocket&utm_medium=leader_board&utm_campaign=ifp_quote_page_banner_adwords","text":"Supplement your coverage with Health Benefit Insurance."},"stm":{"link":"Want a cheaper alternative?","href":"https://www.agilehealthinsurance.com/short-term-health-insurance-quotes?xsell=1&utm_source=healthpocket&utm_medium=leader_board&utm_campaign=ifp_quote_page_banner_adwords","text":"Short Term Health Insurance could be right for you."}}}