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CareSource - CareSource Hoosier Choice Gold
Indiana, 2017
Plan Type
HMO
Metal Tier
Gold
Out of Pocket Maximum
$2,500
Deductible
$1,000
Emergency Room Care: $250 Copay after deductible
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) | $1,000 |
|---|---|
| Deductible (Family) | $2,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $2,500 |
| Out of Pocket Maximum (Family) | $5,000 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | $150 Copay per day |
| Inpatient Physician | 20% Coinsurance after deductible |
| Emergency Room Services | $250 Copay after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | $150 Copay after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 20% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | $75 Copay 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 | $150 Copay per day |
|---|---|
| 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 | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan CareSource Silver | Deductible $3,300 | Coinsurance Not applicable | Out of Pocket $6,400 |
| Plan CareSource Federal Simple Choice Gold | Deductible $1,250 | Coinsurance Not applicable | Out of Pocket $4,750 |
| 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 Gold | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $2,500 |