2018 ElevateHealth Gold 1000 Plan Details - HealthPocket

ElevateHealth Gold 1000

$677.04/mo

Apply For This Plan

Zip Code03103
Applicant11/15/1983 Male
Coverage Start11/17/2018

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameElevateHealth Gold 1000
Plan IDhhs-59025NH0330024
Plan Year2018
Insurance ProviderHarvard Pilgrim
Metal LevelGold
Plan TypeHMO
Deductible$1,000
Out-of-Pocket Maximum$4,000
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 ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNot Applicable
Diagnostic Imaging such as MRIs, CT, and PET scans$50 Copay after deductible
Deductible - Family$2000 per group
Out-of-Pocket Maximum - Family$8000 per group

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs$50 Copay
Non-Preferred Brand Drugs$100 Copay
Specialty Drugs$250 Copay

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$100 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$250 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$250 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$20 Copay
Mental/Behavioral Health Inpatient Services$250 Copay per Stay after deductible
Substance use disorder outpatient services$20 Copay
Substance use disorder inpatient services$250 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
Bariatric Surgery
Hearing Aids
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
Routine Foot Care
Applied Behavior Analysis Based Therapies
Dental Anesthesia
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
Transplant
Well Baby Visits and Care
Bone Marrow Transplant
Off Label Prescription Drugs
Wigs
Low Protein Foods
Convenience Care Clinic
More Limited BenefitsSkilled Nursing Facility
Acupuncture
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Inpatient Rehabilitation Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Treatment for Temporomandibular Joint Disorders
Early Intervention Services
More Excluded BenefitsCosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
PremiumPlan NameDeductible
from $347
Ambetter Secure Care 1 (2019) with 3 Free PCP Visits
$1,000.00Select
from $592
ElevateHealth Options HMO Gold 1000
$1,000.00Select
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold 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 Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold 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 your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold 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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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.

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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.