18 IF PPO 50-NA 0000 P D7350X2 PD

Individual Health Insurance (Obamacare)

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18 IF PPO 50-NA 0000 P D7350X2 PD

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Benefits & Coverage

Plan Name
18 IF PPO 50-NA 0000 P D7350X2 PD
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Expanded Bronze
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$50 Copay
Specialist Visit
$100 Copay
Laboratory Outpatient and Professional Services
$40 Copay
X-rays and Diagnostic Imaging
$100 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
$0 Copay after deductible
Deductible - Family
$14700 per group
Out-of-Pocket Maximum - Family
$14700 per group

Prescription drug coverage

Generic Drugs
$30 Copay
Preferred Brand Drugs
$90 Copay
Non-Preferred Brand Drugs
$140 Copay
Specialty Drugs
100.00% Coinsurance

Access to doctors and hospitals

Provider directory URL
https://apps.hometownhealth.com/OnlineProviderDirectory/
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 - Emergencies and urgent care only outside of Nevada
Does this plan cover services outside the country?
Yes - Emergencies Only

Hospital services

Emergency Room Services
$0 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Not Applicable
Inpatient Physician and Surgical Services
$0 Copay after deductible
Emergency Transportation or Ambulance Service
$0 Copay after deductible

Maternity

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

Mental Health

Mental/Behavioral Health Outpatient Services
$50 Copay
Mental/Behavioral Health Inpatient Services
$0 Copay after deductible
Substance use disorder outpatient services
$50 Copay
Substance use disorder inpatient services
$0 Copay after deductible

Medical Management Programs

Does this plan offer a wellness program?
Not Covered

Vision Coverage

Routine Eye Exam for Children
Included
Eye Glasses for Children
Included
Routine Eye Exam for Adults
Not Covered

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
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 Benefits
Skilled 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 Benefits
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is eligible for a tax credit subsidy

Physician Directory

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