First - my Lehigh Valley Flex Blue HMO 2500S

Pennsylvania, 2017

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $2,500

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) $2,500
Deductible (Family) $5,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $950 Copay per stay
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

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 Not available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient $950 Copay per stay
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% 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

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) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 30% Coinsurance after deductible
Inpatient Facility $950 Copay per stay
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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) $900
Deductible (Family) $1,800
Out of Pocket Maximum (Individual) $1,700
Out of Pocket Maximum (Family) $3,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 10% Coinsurance after deductible
Inpatient Facility $950 Copay per stay
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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) $250
Deductible (Family) $500
Out of Pocket Maximum (Individual) $500
Out of Pocket Maximum (Family) $1,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 10% Coinsurance after deductible
Inpatient Facility $250 Copay per stay
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan my Priority Blue Flex HMO 6800B Deductible $6,800 Coinsurance Not applicable Out of Pocket $7,150
Plan my Priority Blue Flex HMO 2100S Deductible $2,100 Coinsurance Not applicable Out of Pocket $7,150
Plan my Priority Blue Flex HMO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan my Priority Blue Flex HMO 1700GQ Deductible $1,700 Coinsurance Not applicable Out of Pocket $3,250
Plan my Priority Blue Flex HMO 2750SQE Deductible $2,750 Coinsurance Not applicable Out of Pocket $6,000
Plan my Lehigh Valley Flex Blue HMO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,000
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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) $2,500
Deductible (Family) $5,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $950 Copay per stay
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

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 Not available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient $950 Copay per stay
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% 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

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) $5,700
Out of Pocket Maximum (Family) $11,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 30% Coinsurance after deductible
Inpatient Facility $950 Copay per stay
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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) $900
Deductible (Family) $1,800
Out of Pocket Maximum (Individual) $1,700
Out of Pocket Maximum (Family) $3,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 10% Coinsurance after deductible
Inpatient Facility $950 Copay per stay
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

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) $250
Deductible (Family) $500
Out of Pocket Maximum (Individual) $500
Out of Pocket Maximum (Family) $1,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 10% Coinsurance after deductible
Inpatient Facility $250 Copay per stay
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan my Priority Blue Flex HMO 6800B Deductible $6,800 Coinsurance Not applicable Out of Pocket $7,150
Plan my Priority Blue Flex HMO 2100S Deductible $2,100 Coinsurance Not applicable Out of Pocket $7,150
Plan my Priority Blue Flex HMO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $4,000
Plan my Priority Blue Flex HMO 1700GQ Deductible $1,700 Coinsurance Not applicable Out of Pocket $3,250
Plan my Priority Blue Flex HMO 2750SQE Deductible $2,750 Coinsurance Not applicable Out of Pocket $6,000
Plan my Lehigh Valley Flex Blue HMO 1000G Deductible $1,000 Coinsurance Not applicable Out of Pocket $6,000