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Zip Code	55106 (edit)
Applicant	2/19/1984 Male (edit)
Coverage Start	2/20/2019 (edit)

Insurance Type	ACA (Obamacare)
Plan Name	Altru Prime by Medica Gold Copay Plus
Plan ID	hhs-31616MN0410019
Plan Year	2018
Insurance Provider	Medica
Metal Level	Gold
Plan Type	PPO
Deductible	$1,000
Out-of-Pocket Maximum	$5,000
Personal Score
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$30 Copay
Specialist Visit	$30 Copay
Laboratory Outpatient and Professional Services	$30 Copay
X-rays and Diagnostic Imaging	$30 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans	$250 Copay
Deductible - Family	$3000 per group
Out-of-Pocket Maximum - Family	$10000 per group

Prescription drug coverage
Generic Drugs	$5 Copay
Preferred Brand Drugs	$35 Copay
Non-Preferred Brand Drugs	$150 Copay
Specialty Drugs	$250 Copay

Access to doctors and hospitals
Provider directory URL	http://www.medica.com
Does this plan have access to a national provider network?	Yes
Is a referral required to see a Specialist?	Not Covered
Does this plan cover services outside plan service area?	Yes - Out of network benefit
Does this plan cover services outside the country?	Yes - Emergency Services

Hospital services
Emergency Room Services	$150 Copay
Inpatient Hospital Services (e.g., Hospital Stay)	$250 Copay per Day
Inpatient Physician and Surgical Services	30.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service	30.00% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	No Charge
Delivery and all inpatient services for maternity care	30.00% Coinsurance after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$30 Copay
Mental/Behavioral Health Inpatient Services	$250 Copay per Day
Substance use disorder outpatient services	$30 Copay
Substance use disorder inpatient services	$250 Copay per Day

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
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	Not Covered
Child Dental Coverage - Basic Dental Care	Not Covered
Child Dental Coverage - Orthodontia	Not Covered
Child Dental Coverage - Major Dental Care	Not Covered

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 Imaging (CT/PET Scans, MRIs) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Outpatient Rehabilitation Services Habilitation Services Durable Medical Equipment Chiropractic Care Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling 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
More Limited Benefits	Skilled Nursing Facility Hearing Aids Inpatient Physician and Surgical Services Home Health Care Services Hospice Services
More Excluded Benefits	Acupuncture Bariatric Surgery Cosmetic Surgery Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited

+ See All Coverage Details

Premium

Plan Name

Deductible

from $274

North Memorial Acclaim Silver Share

$1,000.00

Select

from $301

Altru Prime by Medica Silver Share

$1,000.00

Select

from $318

Blue Plus Strive - Metro Region Gold $1200 Plan 292

$1,200.00

Select

from $324

Medica Applause Silver Share

$1,000.00

Select

from $330

Blue Plus Northeast MN Gold $1200 Plan 282

$1,200.00

Select

Last Name

Location/Distance

Please select the correct zip

Daly, Patrick

Current, David

Yang, Peter

Feesl, Amy

Henigin, Stephanie

Knutson, Katie

Goodell, Megan

Given, Molly

Mikolajczyk, Kayley

Rosenstein, Benjamin

Meyers, Justin

Harris, Kayla

Starr, William

Haapapuro, Ashley

Henderson, Jennifer

Fahey-ahrndt, Donald

Nichol, Heidi

Nguyen, Tony Huy

Garza, Edmundo

Truong, Chau

Rasmussen, Breanna

Patrick Daly, M.B., B.S

View All Details

Phone Number
(651) 793-3100
Office Locations
651 Arcade St
Saint Paul, MN 55106

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.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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Altru Prime by Medica Gold Copay Plus

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