Medica - Medica Applause Gold Copay Plus

North Dakota, 2017

  • Plan Type

    POS

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $4,000

  • Deductible

    $1,000

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) $1,000
Deductible (Family) $3,000
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 $250 Copay per day
Inpatient Physician 25% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

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 $250 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% 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 North Dakota

Plan Altru Prime by Medica Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Medica Applause Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Altru Prime by Medica Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Altru Prime by Medica Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Medica Applause Silver Copay Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,750
Plan Altru Prime by Medica Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Medica Applause Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Altru Prime by Medica Silver Copay Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,750
Plan Altru Prime by Medica Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Medica Applause Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Altru Prime by Medica Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
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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) $1,000
Deductible (Family) $3,000
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 $250 Copay per day
Inpatient Physician 25% Coinsurance after deductible
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-Ray and Diagnostic Imaging Data Not Available

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 $250 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% 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 North Dakota

Plan Altru Prime by Medica Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Medica Applause Bronze H S A Deductible $6,400 Coinsurance Not applicable Out of Pocket $6,400
Plan Altru Prime by Medica Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Gold Copay Deductible $300 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Applause Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Altru Prime by Medica Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Medica Applause Silver Copay Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,750
Plan Altru Prime by Medica Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,150
Plan Medica Applause Silver H S A Deductible $1,300 Coinsurance Not applicable Out of Pocket $5,500
Plan Altru Prime by Medica Silver Copay Deductible $2,600 Coinsurance Not applicable Out of Pocket $5,750
Plan Altru Prime by Medica Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Medica Applause Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Altru Prime by Medica Catastrophic Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150