Market HSA 2000 - Gold

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
Market HSA 2000 - 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
0% Coinsurance after deductible
Specialist Visit
0% Coinsurance after deductible
Laboratory Outpatient and Professional Services
0% Coinsurance after deductible
X-rays and Diagnostic Imaging
0% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
0% Coinsurance after deductible
Deductible - Family
$4000
Out-of-Pocket Maximum - Family
$4000

Prescription drug coverage

Generic Drugs
0% Coinsurance after deductible
Preferred Brand Drugs
0% Coinsurance after deductible
Non-Preferred Brand Drugs
0% Coinsurance after deductible
Specialty Drugs
0% Coinsurance after deductible

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

Maternity

Prenatal and Postnatal Care
0% Coinsurance after deductible
Delivery and all inpatient services for maternity care
0% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
0% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
0% Coinsurance after deductible
Substance use disorder outpatient services
0% Coinsurance after deductible
Substance use disorder inpatient services
0% 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
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
Inpatient Physician and Surgical Services
Habilitation Services
Outpatient Rehabilitation Services
Hospice Services
Durable Medical Equipment
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Prosthetic Devices
Laboratory Outpatient and Professional Services
Nutritional Counseling
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Inpatient Rehabilitation Facilities - Inpatient Services
Inpatient Rehabilitation Facilities - Physician Fees
Vision Correction after Surgery or Accident
Off Label Prescription Drugs
Organ Transplant Services (travel, meals, etc)
Specified Non-Routine Dental Services
More Limited Benefits
Skilled Nursing Facility
Private-Duty Nursing
Home Health Care Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
OP Therapy-Pulmonary
Physical Rehabilitation (Inpatient)
OP Therapy-Cardiac Rehabilitation
Wigs
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Bariatric Surgery
Infertility Treatment
Hearing Aids
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Dental Check-Up for Children
Non-Emergency Care When Traveling Outside the U.S.
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

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