Celtic - Ambetter Balanced Care 3 (2017): Sinai / IlliniCare Health Network

Illinois, 2017

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $6,500

  • Deductible

    $3,000

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) $3,000
Deductible (Family) $6,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,500
Out of Pocket Maximum (Family) $13,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $750 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $600 Copay before deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient $750 Copay per day before deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance 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) $1,250
Deductible (Family) $2,500
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $600 Copay before deductible
Inpatient Facility $750 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance 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

Deductible (Individual) $250
Deductible (Family) $500
Out of Pocket Maximum (Individual) $1,750
Out of Pocket Maximum (Family) $3,500

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room $100 Copay before deductible
Inpatient Facility $200 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance 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

Deductible (Individual) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $425
Out of Pocket Maximum (Family) $850

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room $25 Copay before deductible
Inpatient Facility $50 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Illinois

Plan Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350
Plan Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
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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) $3,000
Deductible (Family) $6,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,500
Out of Pocket Maximum (Family) $13,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $750 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $600 Copay before deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient $750 Copay per day before deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance 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) $1,250
Deductible (Family) $2,500
Out of Pocket Maximum (Individual) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $600 Copay before deductible
Inpatient Facility $750 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance 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

Deductible (Individual) $250
Deductible (Family) $500
Out of Pocket Maximum (Individual) $1,750
Out of Pocket Maximum (Family) $3,500

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room $100 Copay before deductible
Inpatient Facility $200 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance 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

Deductible (Individual) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $425
Out of Pocket Maximum (Family) $850

Doctor Visits

Primary Care Physician No charge
Specialists
Emergency Room $25 Copay before deductible
Inpatient Facility $50 Copay per day before deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx No charge
Preferred Brand Rx
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Illinois

Plan Ambetter Balanced Care 1 (2017): Sinai / IlliniCare Health Network Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 12 Standardized (2017): Sinai / IlliniCare Health Network Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Ambetter Balanced Care 4 (2017): Sinai / IlliniCare Health Network Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Balanced Care 3 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2017): Sinai / IlliniCare Health Network Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Secure Care 1 (2017) with 3 Free PCP Visits: Sinai / IlliniCare Health Network Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,350
Plan Ambetter Balanced Care 1 (2017) + Vision + Adult Dental: Sinai / IlliniCare Health Network Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500