2018 HNE PPO Wise HDHP National Plan Details - HealthPocket

HNE PPO Wise HDHP National

$435.65/mo

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Zip Code02128
Applicant8/18/1983 Male
Coverage Start8/19/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHNE PPO Wise HDHP National
Plan IDhhs-34484MA1310001
Insurance ProviderBMC HealthNet Plan
Metal LevelGold
Plan TypePPO
Deductible$0
Out-of-Pocket Maximum$5,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or IllnessNot Applicable
Specialist VisitNot Applicable
Laboratory Outpatient and Professional ServicesNot Applicable
X-rays and Diagnostic ImagingNot Applicable
Diagnostic Imaging such as MRIs, CT, and PET scansNot Applicable
Deductible - Familyper group not applicable
Out-of-Pocket Maximum - Family$10000 per group

Prescription drug coverage

Generic Drugs$10 Copay after deductible
Preferred Brand Drugs$25 Copay after deductible
Non-Preferred Brand Drugs$75 Copay after deductible
Specialty Drugs$75 Copay after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.hne.com/Provider_lookUp/index.html
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - Urgent or Emergency
Does this plan cover services outside the country?Yes - Urgent or Emergency

Hospital services

Emergency Room ServicesNot Applicable
Inpatient Hospital Services (e.g., Hospital Stay)Not Applicable
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance ServiceNot Applicable

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity careNot Applicable

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
Mental/Behavioral Health Inpatient ServicesNot Applicable
Substance use disorder outpatient servicesNot Applicable
Substance use disorder inpatient servicesNot Applicable

Medical Management Programs

Does this plan offer a wellness program?Not Covered

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)
Bariatric Surgery
Infertility Treatment
Weight Loss Programs
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
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Dental Check-Up for Children
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Acupuncture/Massage
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
  • 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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