2018 Silver Classic Saver 4000 Plan Details - HealthPocket

Silver Classic Saver 4000


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Zip Code72209
Applicant10/18/1983 Male
Coverage Start10/20/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameSilver Classic Saver 4000
Plan IDhhs-70525AR0070004
Plan Year2018
Insurance ProviderQualChoice
Metal LevelSilver
Plan TypePOS
Out-of-Pocket Maximum$5,250
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness45.00% Coinsurance after deductible
Specialist Visit45.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services45.00% Coinsurance after deductible
X-rays and Diagnostic Imaging45.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans45.00% Coinsurance after deductible
Deductible - Family$8000 per group
Out-of-Pocket Maximum - Family$10500 per group

Prescription drug coverage

Generic Drugs45.00% Coinsurance after deductible
Preferred Brand Drugs45.00% Coinsurance after deductible
Non-Preferred Brand Drugs45.00% Coinsurance after deductible
Specialty Drugs45.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://provider-search.qualchoice.com/default.aspx?n=1&qs=1
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - Medical benefits are subject to out-of-network cost sharing
Does this plan cover services outside the country?Yes - Emergency care only

Hospital services

Emergency Room Services45.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)45.00% Coinsurance after deductible
Inpatient Physician and Surgical Services45.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service45.00% Coinsurance after deductible


Prenatal and Postnatal Care45.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care45.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services45.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services45.00% Coinsurance after deductible
Substance use disorder outpatient services45.00% Coinsurance after deductible
Substance use disorder inpatient services45.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Diabetes, Pregnancy
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 CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

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
Hearing Aids
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
Durable Medical Equipment
Hospice Services
Applied Behavior Analysis Based Therapies
Cochlear Implants
Dental Anesthesia
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Accidental Dental
Allergy Testing
Diabetes Education
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Reconstructive Surgery
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Gastric Electrical Stimulation
Off Label Prescription Drugs
Well Child Care
Preventive Drugs
Craniofacial Surgery
More Limited BenefitsSkilled Nursing Facility
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Cardiac Rehabilitation
More Excluded BenefitsAcupuncture
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
PremiumPlan NameDeductible
from $286
Silver Plan 2
from $319
Silver Plan 2
from $323
Silver Classic Saver 4000
from $323
Silver Saver 4000
from $400
Silver Saver 4000
  • 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 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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