2018 HMSA Platinum HMO Plan Details - HealthPocket

HMSA Platinum HMO


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Zip Code96818
Applicant10/17/1983 Male
Coverage Start10/19/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHMSA Platinum HMO
Plan IDhhs-18350HI0890003
Plan Year2018
Insurance ProviderHMSA
Metal LevelPlatinum
Plan TypeHMO
Out-of-Pocket Maximum$7,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$10 Copay
Specialist Visit$20 Copay
Laboratory Outpatient and Professional Services$10 Copay
X-rays and Diagnostic Imaging$10 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans$100 Copay
Deductible - Family$0 per group
Out-of-Pocket Maximum - Family$14300 per group

Prescription drug coverage

Generic Drugs$7 Copay
Preferred Brand Drugs$30 Copay
Non-Preferred Brand Drugs$75 Copay
Specialty Drugs20.00% Coinsurance

Access to doctors and hospitals

Provider directory URLhttp://www.hmsa.com/
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Yes - Refer to plan for details
Does this plan cover services outside plan service area?Yes - Covered for certain services
Does this plan cover services outside the country?Yes - Covered for certain services

Hospital services

Emergency Room Services$250 Copay
Inpatient Hospital Services (e.g., Hospital Stay)$300 Copay per Day
Inpatient Physician and Surgical Services10.00% Coinsurance
Emergency Transportation or Ambulance Service10.00% Coinsurance


Prenatal and Postnatal Care10.00% Coinsurance
Delivery and all inpatient services for maternity care10.00% Coinsurance

Mental Health

Mental/Behavioral Health Outpatient Services$10 Copay
Mental/Behavioral Health Inpatient ServicesNo Charge
Substance use disorder outpatient services$10 Copay
Substance use disorder inpatient servicesNo Charge

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy
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
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Non-Emergency Care When Traveling Outside the U.S.
Applied Behavior Analysis Based Therapies
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Diabetes Education
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Well Baby Visits and Care
Autism Spectrum Disorders
Prescription Drugs Other
Gender Identity Serivces
Orthodontic Services for the Treatment of Orofacial Anomlies
More Limited BenefitsSkilled Nursing Facility
Infertility Treatment
Home Health Care Services
Chiropractic Care
More Excluded BenefitsCosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Treatment for Temporomandibular Joint Disorders
PremiumPlan NameDeductible
from $371
KP Gold I $20 - Fit
from $375
KP Gold I $20 - ChiroAcuMassage - Fit
from $396
from $418
KP Platinum $10 - Fit
from $422
KP Platinum $10 - ChiroAcuMassage - Fit
  • 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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