CareSource - CareSource Federal Simple Choice Gold

Indiana, 2017

  • Plan Type

    HMO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $4,750

  • Deductible

    $1,250

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) $1,250
Deductible (Family) $2,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $4,750
Out of Pocket Maximum (Family) $9,500

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $250 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging 20% 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 Not available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 20% Coinsurance after deductible
Outpatient Facility 20% Coinsurance after deductible
Outpatient Surgery 20% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Indiana

Plan CareSource Silver Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Hoosier Choice Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Low Premium Silver Deductible $6,150 Coinsurance Not applicable Out of Pocket $7,000
Plan CareSource Hoosier Choice Silver Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Gold Dental and Vision Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500
Plan CareSource Hoosier Choice Gold Dental and Vision Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500
Plan CareSource Bronze Dental and Vision Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Silver Dental and Vision Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Federal Simple Choice Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan CareSource Hoosier Choice Bronze Dental and Vision Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Hoosier Choice Silver Dental and Vision Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Federal Simple Choice Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan CareSource Hoosier Choice Gold Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500
Plan CareSource Gold Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500
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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) $1,250
Deductible (Family) $2,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $4,750
Out of Pocket Maximum (Family) $9,500

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $250 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 20% Coinsurance after deductible
Laboratory Outpatient and Professional Services 20% Coinsurance after deductible
X-Ray and Diagnostic Imaging 20% 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 Not available

Other

Mental / Behavioral Health Inpatient 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 20% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 20% Coinsurance after deductible
Outpatient Facility 20% Coinsurance after deductible
Outpatient Surgery 20% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Indiana

Plan CareSource Silver Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Hoosier Choice Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Low Premium Silver Deductible $6,150 Coinsurance Not applicable Out of Pocket $7,000
Plan CareSource Hoosier Choice Silver Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Gold Dental and Vision Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500
Plan CareSource Hoosier Choice Gold Dental and Vision Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500
Plan CareSource Bronze Dental and Vision Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Silver Dental and Vision Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Federal Simple Choice Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan CareSource Hoosier Choice Bronze Dental and Vision Deductible $6,650 Coinsurance Not applicable Out of Pocket $6,850
Plan CareSource Hoosier Choice Silver Dental and Vision Deductible $3,300 Coinsurance Not applicable Out of Pocket $6,400
Plan CareSource Federal Simple Choice Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,150
Plan CareSource Hoosier Choice Gold Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500
Plan CareSource Gold Deductible $1,000 Coinsurance Not applicable Out of Pocket $2,500