Harvard - ElevateHealth Bronze HSA 6300

New Hampshire, 2017

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $6,450

  • Deductible

    $6,300

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) $6,300
Deductible (Family) $12,600
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,450
Out of Pocket Maximum (Family) $12,900

Doctor Visits

Primary Care Visit No charge after deductible
Specialist Visit No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services No charge after deductible
X-Ray and Diagnostic Imaging No charge 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 Available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient No charge after deductible
Rehabilitative Speech Therapy No charge after deductible
Rehabilitative Occupational & Physical Therapy No charge after deductible
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx 25% Coinsurance after deductible
Preferred Brand Rx 25% Coinsurance after deductible
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs 25% Coinsurance after deductible

Other Plans in New Hampshire

Plan New Hampshire Network Silver 2500 Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,850
Plan ElevateHealth Gold HSA 1500 Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,500
Plan ElevateHealth Silver 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,850
Plan ElevateHealth Silver HSA 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $5,000
Plan New Hampshire Network Gold 1000 Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,850
Plan ElevateHealth Bronze 5750 Deductible $5,750 Coinsurance Not applicable Out of Pocket $7,000
Plan New Hampshire Network Bronze HSA 5100 Deductible $5,100 Coinsurance Not applicable Out of Pocket $6,550
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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) $6,300
Deductible (Family) $12,600
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,450
Out of Pocket Maximum (Family) $12,900

Doctor Visits

Primary Care Visit No charge after deductible
Specialist Visit No charge after deductible
Inpatient Facility No charge after deductible
Inpatient Physician No charge after deductible
Emergency Room Services No charge after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) No charge after deductible
Laboratory Outpatient and Professional Services No charge after deductible
X-Ray and Diagnostic Imaging No charge 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 Available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient No charge after deductible
Rehabilitative Speech Therapy No charge after deductible
Rehabilitative Occupational & Physical Therapy No charge after deductible
Outpatient Facility No charge after deductible
Outpatient Surgery No charge after deductible

Prescription Drugs

Generic Rx 25% Coinsurance after deductible
Preferred Brand Rx 25% Coinsurance after deductible
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs 25% Coinsurance after deductible

Other Plans in New Hampshire

Plan New Hampshire Network Silver 2500 Deductible $2,500 Coinsurance Not applicable Out of Pocket $6,850
Plan ElevateHealth Gold HSA 1500 Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,500
Plan ElevateHealth Silver 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,850
Plan ElevateHealth Silver HSA 3000 Deductible $3,000 Coinsurance Not applicable Out of Pocket $5,000
Plan New Hampshire Network Gold 1000 Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,850
Plan ElevateHealth Bronze 5750 Deductible $5,750 Coinsurance Not applicable Out of Pocket $7,000
Plan New Hampshire Network Bronze HSA 5100 Deductible $5,100 Coinsurance Not applicable Out of Pocket $6,550