Wellmark - Wellmark Synergy Gold 2500

Iowa, 2017

  • Plan Type

    HMO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $4,000

  • Deductible

    $2,500

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

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) $2,500
Deductible (Family) $5,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $4,000
Out of Pocket Maximum (Family) $8,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging No charge

Health Management Programs

Asthma Not available
Depression Not available
Diabetes Not available
Heart Disease Not available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy No charge
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

Other Plans in Iowa

Plan Wellmark Synergy Bronze 6500 Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Wellmark Synergy Silver 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
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Cost Sharing Benefits (In Network)

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) $2,500
Deductible (Family) $5,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $4,000
Out of Pocket Maximum (Family) $8,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging No charge

Health Management Programs

Asthma Not available
Depression Not available
Diabetes Not available
Heart Disease Not available
High Blood Pressure / High Cholesterol Not available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Not available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy No charge
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

Other Plans in Iowa

Plan Wellmark Synergy Bronze 6500 Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Wellmark Synergy Silver 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600