Sanford - Sanford Simplicity $1,250

North Dakota, 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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not 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 Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
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 30% Coinsurance after deductible

Other Plans in North Dakota

Plan Sanford Simplicity $3,500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $4,000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Sanford TRUE $4,000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Sanford TRUE $6,000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $6,000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $5,000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Sanford TRUE $5,000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Sanford TRUE $3,500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $7,150 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) $1,250
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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not 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 Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
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 30% Coinsurance after deductible

Other Plans in North Dakota

Plan Sanford Simplicity $3,500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $4,000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Sanford TRUE $4,000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Sanford TRUE $6,000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $6,000 Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $5,000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Sanford TRUE $5,000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Sanford TRUE $3,500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Sanford Simplicity $7,150 Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150