Maine - Communty Focus

Maine, 2017

  • Plan Type

    PPO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $5,500

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) $5,500
Deductible (Family) $11,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Maine

Plan Community Reliant HSA Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Community Align Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Value Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Choice Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,500
Plan Community Safe Harbor Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Edge Deductible $1,200 Coinsurance Not applicable Out of Pocket $4,300
Plan Community Complete Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Advance Deductible $2,000 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) $5,500
Deductible (Family) $11,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

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

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Maine

Plan Community Reliant HSA Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,550
Plan Community Align Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Value Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Choice Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,500
Plan Community Safe Harbor Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Edge Deductible $1,200 Coinsurance Not applicable Out of Pocket $4,300
Plan Community Complete Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Community Advance Deductible $2,000 Coinsurance Not applicable Out of Pocket $6,500