Hometown HealthPPO

Hometown HealthPPO | 16 IF PPO 50-00 CINS U D1300X2 HSA

  • 16 IF PPO 50-00 CINS U D1300X2 HSA is an Obamacare health insurance plan offered by Hometown HealthPPO that is available for individuals and families.

  • This plan is a PPO, meaning you will have the flexibility to visit a preferred healthcare provider network that have preferred rates for in-network physicians. (Read more about PPOs.)

  • This plan is a Bronze metal level plan, which generally has a lower monthly cost but higher annual deductible (and co-pay), and provides basic insurance coverage for people who do not spend regularly on health care (i.e., doctors, prescription drugs, etc.).

  • Deductible amount of $1,300. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of $6,550, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.


Ways to Enroll or Learn More

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Plan Summary

Monthly Cost

Plan Name:
16 IF PPO 50-00 CINS U D1300X2 HSA

Plan ID:
85266NV0030080

Plan Type:
PPO

Deductible:
$1,300

Maximum Out-of-Pocket:
$6,550

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a lower monthly cost is great for healthy individuals and families who rarely, if ever, visit the doctor or use prescription drugs. The low deductible on this plan means you won't have to pay as much money out of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. Plans with this type of provider network tend to have a more broad provider network.

HealthCare.com is a privately-held internet start-up for healthcare consumers. We’re not the government website.

Highlights


Emergency Room:
CYD then 100% paid by member

Retail Drugs:
$80 Copay after deductible

Generic Drugs:
$30 Copay after deductible

Overview


Plan Type:
PPO

Metal Level:
Bronze

Health Spending Account:

Primary Care Office Visit:
$50 Copay after deductible

Specialist Office Visit:
$100 Copay after deductible

Out of Network Coverage:
Not Covered

Out of Country Coverage:
Not Covered

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
CYD then 100% paid by member

Inpatient

Hospital Services
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
Physician Fee
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
Skilled Nursing Facility
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
Mental Health
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
Substance Abuse
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
Home Healthcare
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member

Outpatient

Surgery
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
X-ray and Diagnostics
In Network:
$100 Copay after deductible

Out of Network:
CYD then 100% paid by member
Labs
In Network:
$50 Copay after deductible

Out of Network:
CYD then 100% paid by member
Facility Fee
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
Mental Health
In Network:
$50 Copay after deductible

Out of Network:
CYD then 100% paid by member
Substance Abuse
In Network:
$50 Copay after deductible

Out of Network:
CYD then 100% paid by member
Rehabilitation Services
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

Out of Network:
CYD then 100% paid by member
Labor and Delivery Inpatient Services
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
30% Coinsurance after deductible
Glasses (Child)
In Network:
No Charge after deductible

Out of Network:
30% Coinsurance after deductible

Additional Coverage

Habilitation Services
In Network:
CYD then 50%

Out of Network:
CYD then 100% paid by member
Hospice Service
In Network:
$100 Copay after deductible

Out of Network:
CYD then 100% paid by member
Durable Medical Equipment
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member

Doctor Visits

Primary Care Visit
In Network:
$50 Copay after deductible

Out of Network:
CYD then 100% paid by member
Specialist Visit
In Network:
$100 Copay after deductible

Out of Network:
CYD then 100% paid by member
Other Practitioner Office Visit
In Network:
$50 Copay after deductible

Out of Network:
CYD then 100% paid by member
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
CYD then 100% paid by member

Emergency Room and Urgent Care

Emergency Room Services
In Network:
CYD then 100% paid by member

Out of Network:
CYD then 100% paid by member
Urgent Care Services
In Network:
$100 Copay after deductible

Out of Network:
CYD then 100% paid by member
Ambulance/Transportation Services
In Network:
CYD then 100%

Out of Network:
CYD then 100% paid by member

Drugs

Generic Prescription
In Network:
$30 Copay after deductible

Out of Network:
Not Applicable
Retail Brand Drugs
In Network:
$80 Copay after deductible

Out of Network:
Not Applicable
Non Retail Brand Drugs
In Network:
60% Coinsurance after deductible

Out of Network:
Not Applicable
Specialty Drugs
In Network:
40% Coinsurance after deductible

Out of Network:
Not Applicable

Additional Plan Information

Summary Of Benefits:

Provider Information:

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

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