Ambetter Ambetter Silver 2 (Arkansas)

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Company Ambetter of Arkansas
Plan Year 2014
State Arkansas
Metal Tier Silver
Plan Type PPO
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Cost Sharing Benefits (In Network)

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $3,000
Deductible (Family) $6,000
Coinsurance 20%
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit $50
Specialist Visit $75
In Patient Hospital Services $1000 Copay per Day
Emergency Room Services $250 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $150 copay
Laboratory Outpatient and Professional Services $50 copay
X-ray and Diagnostic Imaging $50 copay

Other

Mental / Behavioral Health $50 copay
Rehabilitative Speech Therapy $50 copay
Rehabilitative Occupational & Physical Therapy $50 copay
Outpatient Facility 20% coinsurance
Outpatient Surgery 20% coinsurance

Prescription Drugs

Generic Rx $10
Preferred Brand Rx $50
Non Preferred Brand Rx $100 Copay after deductible
Specialty Drugs $250 Copay after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $2,500.00
Deductible (Family) $5,000.00
Out of Pocket Maximum (Individual) $5,200.00
Out of Pocket Maximum (Family) $10,400.00
Primary Care Physician $15
Specialists $30
Emergency Room $150 Copay after deductible
Inpatient Facility $1000 Copay per Day
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $25
Non Preferred Brand Rx $50 Copay after deductible
Specialty Drugs $250 Copay after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $500.00
Deductible (Family) $1,000.00
Out of Pocket Maximum (Individual) $2,250.00
Out of Pocket Maximum (Family) $4,500.00
Services In Network Out of Network
Primary Care Physician $10
Specialists $20
Emergency Room $100 Copay after deductible
Inpatient Facility $250 Copay per Day
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx $20
Non Preferred Brand Rx $40 Copay after deductible
Specialty Drugs $250 Copay after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $150.00
Deductible (Family) $300.00
Out of Pocket Maximum (Individual) $754.00
Out of Pocket Maximum (Family) $1,508.00
Services In Network Out of Network
Primary Care Physician $8
Specialists $10
Emergency Room $20
Inpatient Facility $140 Copay per Day
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $4.00
Preferred Brand Rx $4
Non Preferred Brand Rx $8
Specialty Drugs $8

Other Plans

Other plans that are available in the state.

Plan Name
Ambetter Secure Care 1
Ambetter Secure Care 2 with 3 Free PCP Visits
Ambetter Balanced Care 1
Ambetter Balanced Care 2
Ambetter Essential Care 1
Ambetter Essential Care 2 with 3 Free PCP Visits
Ambetter Secure Care 1 + Vision
Ambetter Secure Care 2 with 3 Free PCP Visits + Vision
Ambetter Balanced Care 1 + Vision
Ambetter Balanced Care 2 + Vision
Ambetter Essential Care 1 + Vision
Ambetter Essential Care 2 with 3 Free PCP Visits + Vision
Ambetter Secure Care 1 + Vision + Adult Dental
Ambetter Secure Care 2 with 3 Free PCP Visits + Vision + Adult Dental
Ambetter Balanced Care 1 + Vision + Adult Dental
Ambetter Balanced Care 2 + Vision + Adult Dental
Ambetter Essential Care 1 + Vision + Adult Dental
Ambetter Essential Care 2 with 3 Free PCP Visits + Vision + Adult Dental

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