2018 18 IF HMO 20-CO 1200 A D0500X2 Plan Details - HealthPocket

18 IF HMO 20-CO 1200 A D0500X2

$541.96/mo

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Zip Code89110
Applicant8/16/1983 Male
Coverage Start8/17/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan Name18 IF HMO 20-CO 1200 A D0500X2
Plan IDhhs-41094NV0030043
Insurance ProviderHOMETOWN HEALTH PLAN, INC
Metal LevelGold
Plan TypeHMO
Deductible$500
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 Services$25 Copay
X-rays and Diagnostic Imaging$60 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans$225 Copay
Deductible - Family$1000 per group
Out-of-Pocket Maximum - Family$8000 per group

Prescription drug coverage

Generic Drugs$10 Copay
Preferred Brand Drugs$40 Copay
Non-Preferred Brand Drugs$80 Copay
Specialty Drugs20.00% Coinsurance

Access to doctors and hospitals

Provider directory URLhttps://apps.hometownhealth.com/OnlineProviderDirectory/
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All except OBGYN
Does this plan cover services outside plan service area?Yes - Emergencies and urgent care only outside of Nevada
Does this plan cover services outside the country?Yes - Emergencies Only

Hospital services

Emergency Room Services$500 Copay
Inpatient Hospital Services (e.g., Hospital Stay)$1200 Copay
Inpatient Physician and Surgical Services$0 Copay
Emergency Transportation or Ambulance Service20.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care$0 Copay
Delivery and all inpatient services for maternity care$1200 Copay

Mental Health

Mental/Behavioral Health Outpatient Services$20 Copay
Mental/Behavioral Health Inpatient Services$1200 Copay
Substance use disorder outpatient services$20 Copay
Substance use disorder inpatient services$1200 Copay

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 AdultsNot Covered

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)
Preventive Care/Screening/Immunization
Private-Duty Nursing
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
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
More Limited BenefitsSkilled Nursing Facility
Acupuncture
Bariatric Surgery
Hearing Aids
Infertility Treatment
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Dental Check-Up for Children
Chiropractic Care
Nutritional Counseling
Prosthetic Devices
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsCosmetic Surgery
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $333
Standard Life Select STM Plan 3 500/30/1M
$500.00Select
from $363
Standard Life Select STM Plan 3 500/20/1M
$500.00Select
from $446
Standard Life Select STM Plan 3 500/0/1M
$500.00Select
from $558
18 IF HMO 20-CO 1200 A D0500X2 PD
$500.00Select
  • 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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