PacificSource SmartAlliance Balance Bronze 6350 ID

Plan Information
Company PacificSource Health Plans
State ID
Metal Tier Bronze
Plan Type HMO

Cost Sharing Benefits

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.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $6,350 $12,000
Deductible (Family) $12,700 $24,000
Coinsurance Data Not Available 50%
Out of Pocket Maximum (Individual) $6,350 $24,000
Out of Pocket Maximum (Family) $12,700 $48,000
Services In Network Out of Network
Primary Care Visit $50 Copay before deductible 50% coinsurance
Specialist Visit $50 Copay before deductible 50% coinsurance
In Patient Hospital Services No Charge after deductible 50% coinsurance
Emergency Room Services No Charge after deductible No charge
Mental / Behavioral Health First 3 combined visits $50 co-pay/visit, then No charge 50% coinsurance
Imaging (CT/PET Scans, MRIs) No charge 50% coinsurance
Rehabilitative Speech Therapy No charge 50% coinsurance
Rehabilitative Occupational & Physical Therapy No charge 50% coinsurance
Preventative Care $0 50% coinsurance
Laboratory Outpatient and Professional Services No charge 50% coinsurance
X-ray and Diagnostic Imaging No charge 50% coinsurance
Prescription Drugs In Network Out of Network
Generic Rx $10 Copay before deductible
Preferred Brand Rx No Charge after deductible
Non Preferred Brand Rx No Charge after deductible
Specialty Drugs No Charge after deductible

Other Plans

Other plans that are available in the state.

Plan Name
BrightIdea Balance Bronze 6350
BrightIdea Value Bronze 3000
BrightIdea Value Bronze 6250
SmartAlliance Balance Bronze 6350
SmartAlliance Value Bronze 3000
SmartAlliance Value Bronze 6250
SmartHealth Balance Bronze 6350
SmartHealth Value Bronze 3000
SmartHealth Value Bronze 6250
BrightIdea Catastrophic
SmartAlliance Catastrophic
SmartHealth Catastrophic
BrightIdea Balance Gold 1000
SmartAlliance Balance Gold 1000
SmartHealth Balance Gold 500
BrightIdea Balance Silver 2500
BrightIdea Value Silver 3600
SmartAlliance Balance Silver 2500
SmartAlliance Value Silver 3600
SmartHealth Balance Silver 2500
SmartHealth Value Silver 3600
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This tool is for research purposes only. The numbers shown are estimates based on the information you have provided and our best efforts to provide accurate data. We try to keep the information up to date however we cannot make warranties about the accuracy of our information. We advise that users confirm any research with the respective health insurance companies and health exchanges.