2018 Gold 80 HMO Coinsurance Plan Details - HealthPocket

Gold 80 HMO Coinsurance

$451.60/mo

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Zip Code90011
Applicant8/21/1983 Male
Coverage Start8/22/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameGold 80 HMO Coinsurance
Plan IDhhs-40513CA0390021
Insurance ProviderKaiser Permanente
Metal LevelGold
Plan TypeHMO
Deductible$0
Out-of-Pocket Maximum$6,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit$55 Copay
Laboratory Outpatient and Professional Services$35 Copay
X-rays and Diagnostic Imaging$55 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans20.00% Coinsurance
Deductible - Family$0 per group
Out-of-Pocket Maximum - Family$12000 per group

Prescription drug coverage

Generic Drugs$15 Copay
Preferred Brand Drugs$55 Copay
Non-Preferred Brand Drugs$55 Copay
Specialty Drugs20.00% Coinsurance

Access to doctors and hospitals

Provider directory URLhttps://members.kaiserpermanente.org/kpweb/medicalstaffdir/entrypage.do
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All
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$325 Copay
Inpatient Hospital Services (e.g., Hospital Stay)20.00% Coinsurance
Inpatient Physician and Surgical Services20.00% Coinsurance
Emergency Transportation or Ambulance Service$250 Copay

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care20.00% Coinsurance

Mental Health

Mental/Behavioral Health Outpatient Services$25 Copay
Mental/Behavioral Health Inpatient Services20.00% Coinsurance
Substance use disorder outpatient services$25 Copay
Substance use disorder inpatient services20.00% Coinsurance

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
Acupuncture
Bariatric Surgery
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
Dental Check-Up for Children
Routine Foot Care
Dental Anesthesia
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Second Opinion
Abortion for Which Public Funding is Prohibited
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Clinical Trials
Coverage for Effects of Diethylstilbestrol
Off Label Prescription Drugs
Organ Transplants
Prescription Drugs Other
Mastectomy-Related Coverage
Delivery and all Inpatient Services Professional Fee
Emergency Room Physician Fee
Mental/Behavioral Health Inpatient Professional Fee
Outpatient Services Office Visit
Substance Use Disorder Inpatient Professional Fee
Deliveray and all Inpatient Services Professional Fee
Emergency Room Professional Fees
More Limited BenefitsSkilled Nursing Facility
Home Health Care Services
More Excluded BenefitsCosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Chiropractic Care
Non-Emergency Care When Traveling Outside the U.S.
Accidental Dental
Nutritional Counseling
PremiumPlan NameDeductible
from $322
Gold 80 HMO Trio Mirrored
$0.00Select
from $401
Gold 80 PPO Mirrored
$0.00Select
from $434
Platinum 90 HMO Trio Mirrored
$0.00Select
from $475
Gold 80 HMO
$0.00Select
from $521
Platinum 90 HMO
$0.00Select
  • 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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