2018 Total HMO Standard Plan Details - HealthPocket

Total HMO Standard

$243.93/mo

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Zip Code48228
Applicant8/15/1983 Male
Coverage Start8/16/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameTotal HMO Standard
Plan IDhhs-67183MI0030001
Insurance ProviderTotal Health Care
Metal LevelGold
Plan TypeHMO
Deductible$1,000
Out-of-Pocket Maximum$5,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay
Specialist Visit$60 Copay
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic Imaging$60 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans$350 Copay
Deductible - Family$2000 per group
Out-of-Pocket Maximum - Family$10000 per group

Prescription drug coverage

Generic Drugs$25 Copay
Preferred Brand Drugs$50 Copay
Non-Preferred Brand Drugs$100 Copay
Specialty Drugs30.00% Coinsurance

Access to doctors and hospitals

Provider directory URLhttp://www.thcmi.com
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - Podiatry, Chiropractic
Does this plan cover services outside plan service area?Yes - Emergency
Does this plan cover services outside the country?Yes - Emergency

Hospital services

Emergency Room Services$350 Copay
Inpatient Hospital Services (e.g., Hospital Stay)No Charge after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Emergency Transportation or Ambulance Service$75 Copay

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity careNo Charge after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$60 Copay
Mental/Behavioral Health Inpatient ServicesNo Charge after deductible
Substance use disorder outpatient services$60 Copay
Substance use disorder inpatient servicesNo Charge after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

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
Cosmetic Surgery
Infertility Treatment
Weight Loss Programs
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
Home Health Care Services
Durable Medical Equipment
Hospice Services
Mental Health Other
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Prescription Drugs Other
Habilitative Devices
Rehabilitative Devices
More Limited BenefitsSkilled Nursing Facility
Bariatric Surgery
Hearing Aids
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Eyeglasses for Adults
More Excluded BenefitsAcupuncture
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
PremiumPlan NameDeductible
from $143
Short Term Medical Value 1000/30/11000
$1,000.00Select
from $148
Short Term Medical Value 1000/30/6000
$1,000.00Select
from $167
Standard Life Select STM Plan 3 1000/30/1M
$1,000.00Select
from $178
Standard Life Select STM Plan 3 1000/20/1M
$1,000.00Select
from $168
Short Term Medical Plus 1000/30/6000
$1,000.00Select
  • 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.

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