Keystone Health Plan Central*

Keystone Health Plan Central* | Healthy Benefits Value HMO 0.0.10

  • Healthy Benefits Value HMO 0.0.10 is an Obamacare health insurance plan offered by Keystone Health Plan Central* that is available for individuals and families.

  • This plan is a HMO, meaning you will have to stay within the insurance company’s network, and will need to see a primary care doctor first and get a referral in order to see a specialist. (Read more about HMOs.)

  • This plan is a Platinum metal level plan, which has the highest monthly cost, and for that cost provides the highest coverage (in terms of lowest deductibles and co-pays). Platinum plans are best for those who expect to use their health care benefits a lot throughout the year.

  • Deductible amount of No Charge. 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 $6,850, 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:
Healthy Benefits Value HMO 0.0.10

Plan ID:
53789PA0110040

Plan Type:
HMO

Deductible:
No Charge

Maximum Out-of-Pocket:
$6,850

Summary of Benefits:

Provider Information:

Who is this plan for?

This plan with a higher monthly cost is great for individuals and families who have multiple, serious, or chronic health needs, regularly visit the doctor, and regularly use multiple 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 narrower provider network.

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

Highlights


Dental Coverage:
Child

Emergency Room:
$100

Retail Drugs:
$42

Generic Drugs:
$6

Overview


Plan Type:
HMO

Metal Level:
Platinum

Health Spending Account:
No

Primary Care Office Visit:
$10

Specialist Office Visit:
$25

Out of Network Coverage:
Yes

Out of Country Coverage:
Yes

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
Not Covered
Well Baby Care
In Network:
No Charge

Out of Network:
Not Covered

Inpatient

Hospital Services
In Network:
No Charge

Out of Network:
Not Covered
Physician Fee
In Network:
No Charge

Out of Network:
Not Covered
Skilled Nursing Facility
In Network:
No Charge

Out of Network:
Not Covered
Mental Health
In Network:
No Charge

Out of Network:
Not Covered
Substance Abuse
In Network:
No Charge

Out of Network:
Not Covered
Home Healthcare
In Network:
No Charge

Out of Network:
Not Covered

Outpatient

Surgery
In Network:
No Charge

Out of Network:
Not Covered
X-ray and Diagnostics
In Network:
No Charge

Out of Network:
Not Covered
Labs
In Network:
No Charge

Out of Network:
Not Covered
Facility Fee
In Network:
No Charge

Out of Network:
Not Covered
Mental Health
In Network:
$25

Out of Network:
Not Covered
Substance Abuse
In Network:
$25

Out of Network:
Not Covered
Rehabilitation Services
In Network:
$25

Out of Network:
Not Covered

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

Out of Network:
Not Covered
Labor and Delivery Inpatient Services
In Network:
No Charge

Out of Network:
Not Covered

Dental

Accidental Care
In Network:
No Charge

Out of Network:
Not Covered
Basic Dental Care (Child)
In Network:
50% Coinsurance after deductible

Out of Network:
70% Coinsurance after deductible
Dental Checkup (Child)
In Network:
No Charge

Out of Network:
20%
Major Dental Care (Child)
In Network:
50% Coinsurance after deductible

Out of Network:
70% Coinsurance after deductible
Orthodontia (Child)
In Network:
50% Coinsurance after deductible

Out of Network:
Not Covered

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
70%
Glasses (Child)
In Network:
No Charge

Out of Network:
70%

Additional Coverage

Chiropractic Care
In Network:
$25

Out of Network:
Not Covered
Habilitation Services
In Network:
$25

Out of Network:
Not Covered
Rehabilitation Services (Speech)
In Network:
$25

Out of Network:
Not Covered
Rehabilitation Services (Occupational Therapy)
In Network:
$25

Out of Network:
Not Covered
Hospice Service
In Network:
No Charge

Out of Network:
Not Covered
Diabetes Care Management
In Network:
No Charge

Out of Network:
Not Covered
Durable Medical Equipment
In Network:
No Charge

Out of Network:
Not Covered
Reconstructive Surgery
In Network:
No Charge

Out of Network:
Not Covered

Doctor Visits

Primary Care Visit
In Network:
$10

Out of Network:
Not Covered
Specialist Visit
In Network:
$25

Out of Network:
Not Covered
Other Practitioner Office Visit
In Network:
$25

Out of Network:
Not Covered
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
Not Covered

Emergency Room and Urgent Care

Emergency Room Services
In Network:
$100

Out of Network:
$100
Urgent Care Services
In Network:
$50

Out of Network:
$50
Ambulance/Transportation Services
In Network:
No Charge

Out of Network:
No Charge

Drugs

Generic Prescription
In Network:
$6

Out of Network:
Not Covered
Retail Brand Drugs
In Network:
$42

Out of Network:
Not Covered
Non Retail Brand Drugs
In Network:
$67

Out of Network:
Not Covered
Specialty Drugs
In Network:
$200

Out of Network:
Not Covered

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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