Market Classic 1000 - Gold

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
Market Classic 1000 - Gold
Plan Year
2015
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Gold
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$25 Copay
Specialist Visit
$50 Copay
Laboratory Outpatient and Professional Services
20% Coinsurance after deductible
X-rays and Diagnostic Imaging
20% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
20% Coinsurance after deductible
Deductible - Family
$2000
Out-of-Pocket Maximum - Family
$10000

Prescription drug coverage

Generic Drugs
$15 Copay
Preferred Brand Drugs
$30 Copay
Non-Preferred Brand Drugs
50% Coinsurance
Specialty Drugs
50% Coinsurance

Access to doctors and hospitals

Provider directory URL
http://www.medmutual.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 - Covered as Non-Network
Does this plan cover services outside the country?
Yes - Emergency Only

Hospital services

Emergency Room Services
$250 Copay
Inpatient Hospital Services (e.g., Hospital Stay)
$0 Copay per Day, 20% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services
20% Coinsurance after deductible
Emergency Transportation or Ambulance Service
20% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care
20% Coinsurance after deductible
Delivery and all inpatient services for maternity care
20% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$25 Copay
Mental/Behavioral Health Inpatient Services
20% Coinsurance after deductible
Substance use disorder outpatient services
20% Coinsurance after deductible
Substance use disorder inpatient services
20% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?
Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, High Blood Pressure & High Cholesterol, Low Back Pain
Does this plan offer a wellness program?
Included

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
Specified Non-Routine Dental Services
Organ Transplant Services (travel, meals, etc)
Off Label Prescription Drugs
Vision Correction after Surgery or Accident
Inpatient Rehabilitation Facilities - Physician Fees
Inpatient Rehabilitation Facilities - Inpatient Services
Well Baby Visits and Care
Treatment for Temporomandibular Joint Disorders
Transplant
Reconstructive Surgery
Radiation
Nutritional Counseling
Laboratory Outpatient and Professional Services
Prosthetic Devices
Infusion Therapy
Dialysis
Diabetes Education
Chemotherapy
Allergy Testing
Accidental Dental
Durable Medical Equipment
Hospice Services
Outpatient Rehabilitation Services
Habilitation Services
Inpatient Physician and Surgical Services
Urgent Care Centers or Facilities
Outpatient Surgery Physician/Surgical Services
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Other Practitioner Office Visit (Nurse, Physician Assistant)
More Limited Benefits
Wigs
Physical Rehabilitation (Inpatient)
OP Therapy-Cardiac Rehabilitation
OP Therapy-Pulmonary
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Chiropractic Care
Home Health Care Services
Private-Duty Nursing
Skilled Nursing Facility
More Excluded Benefits
Abortion for Which Public Funding is Prohibited
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.
Dental Check-Up for Children
Weight Loss Programs
Long-Term/Custodial Nursing Home Care
Hearing Aids
Infertility Treatment
Bariatric Surgery
Cosmetic Surgery
Acupuncture

What To Know

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

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