Silver 70 HMO Off Exchange

Individual Health Insurance (Obamacare)

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Silver 70 HMO Off Exchange

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Monthly Cost



Benefits & Coverage

Plan Name
Silver 70 HMO Off Exchange
Plan Year
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$35 Copay
Specialist Visit
$75 Copay
Laboratory Outpatient and Professional Services
$35 Copay
X-rays and Diagnostic Imaging
$75 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans
$300 Copay
Deductible - Family
$5000 per group
Out-of-Pocket Maximum - Family
$14000 per group

Prescription drug coverage

Generic Drugs
$15 Copay after deductible
Preferred Brand Drugs
$55 Copay after deductible
Non-Preferred Brand Drugs
$55 Copay after deductible
Specialty Drugs
20.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URL
Does this plan have access to a national provider network?
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
$350 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
20.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
20.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
$255 Copay after deductible


Prenatal and Postnatal Care
Not Applicable
Delivery and all inpatient services for maternity care
20.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$35 Copay
Mental/Behavioral Health Inpatient Services
20.00% Coinsurance after deductible
Substance use disorder outpatient services
$35 Copay
Substance use disorder inpatient services
20.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer a wellness program?
Not Covered

Vision Coverage

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

Child Dental Coverage

Child Dental Coverage - Routine Dental Care
Child Dental Coverage - Basic Dental Care
Child Dental Coverage - Orthodontia
Child Dental Coverage - Major Dental Care

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
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
Diabetes Education
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
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
Emergency Room Professional Fees
More Limited Benefits
Skilled Nursing Facility
Home Health Care Services
More Excluded Benefits
Cosmetic 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

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is not eligible for a tax credit subsidy

Physician Directory

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Silver plan frequently asked questions (FAQ)

  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver 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 Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver 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 Silver Plan premiums in your area.

  • When Can I Enroll in a Silver Plan?

    The Open Enrollment period for the 2016 Affordable Care Act health plans begins November 1, 2015 and ends January 31, 2016. See our Open Enrollment article for more information.

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