Harvard - ElevateHealth Silver HSA 3000

New Hampshire, 2017

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $5,000

  • Deductible

    $3,000

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) $3,000
Deductible (Family) $6,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit 15% Coinsurance after deductible
Specialist Visit 15% Coinsurance after deductible
Inpatient Facility 15% Coinsurance after deductible
Inpatient Physician 15% Coinsurance after deductible
Emergency Room Services $300 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 15% Coinsurance after deductible
Laboratory Outpatient and Professional Services 15% Coinsurance after deductible
X-Ray and Diagnostic Imaging 15% Coinsurance 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 15% Coinsurance after deductible
Mental / Behavioral Health Outpatient 15% Coinsurance after deductible
Rehabilitative Speech Therapy 15% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 15% Coinsurance after deductible
Outpatient Facility 15% Coinsurance after deductible
Outpatient Surgery 15% Coinsurance after deductible

Prescription Drugs

Generic Rx $15 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $2,500
Deductible (Family) $5,000
Out of Pocket Maximum (Individual) $4,000
Out of Pocket Maximum (Family) $8,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $300 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $15 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx 20% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $750
Deductible (Family) $1,500
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $150 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $5 Copay after deductible
Preferred Brand Rx $20 Copay after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $750
Out of Pocket Maximum (Family) $1,500

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $75 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $5 Copay after deductible
Preferred Brand Rx $20 Copay after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 20% 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 Bronze HSA 6300 Deductible $6,300 Coinsurance Not applicable Out of Pocket $6,450
Plan ElevateHealth Silver 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,850
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) $3,000
Deductible (Family) $6,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit 15% Coinsurance after deductible
Specialist Visit 15% Coinsurance after deductible
Inpatient Facility 15% Coinsurance after deductible
Inpatient Physician 15% Coinsurance after deductible
Emergency Room Services $300 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 15% Coinsurance after deductible
Laboratory Outpatient and Professional Services 15% Coinsurance after deductible
X-Ray and Diagnostic Imaging 15% Coinsurance 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 15% Coinsurance after deductible
Mental / Behavioral Health Outpatient 15% Coinsurance after deductible
Rehabilitative Speech Therapy 15% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 15% Coinsurance after deductible
Outpatient Facility 15% Coinsurance after deductible
Outpatient Surgery 15% Coinsurance after deductible

Prescription Drugs

Generic Rx $15 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $2,500
Deductible (Family) $5,000
Out of Pocket Maximum (Individual) $4,000
Out of Pocket Maximum (Family) $8,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $300 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $15 Copay after deductible
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx 20% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $750
Deductible (Family) $1,500
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $150 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $5 Copay after deductible
Preferred Brand Rx $20 Copay after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 20% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $750
Out of Pocket Maximum (Family) $1,500

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $75 Copay after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx $5 Copay after deductible
Preferred Brand Rx $20 Copay after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 20% 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 Bronze HSA 6300 Deductible $6,300 Coinsurance Not applicable Out of Pocket $6,450
Plan ElevateHealth Silver 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,850
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