Medica - Medica with CHI Health Gold Copay Plus

Nebraska, 2018

  • Plan Type

    PPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $5,000

  • 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) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $250 Copay per day
Inpatient Physician 30% 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 Data Not Available
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

Other Plans in Nebraska

Plan Medica with CHI Health Catastrophic Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica with CHI Health Silver Copay Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,000
Plan Medica with CHI Health Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica Insure Bronze HSA Plus Deductible $2,600 Coinsurance Not applicable Out of Pocket $6,650
Plan Medica Insure Bronze HSA Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Medica Insure Catastrophic Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica Insure Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Insure Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica Insure Silver Copay Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,000
Plan Medica with CHI Health Bronze HSA Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Medica with CHI Health Bronze HSA Plus Deductible $2,600 Coinsurance Not applicable Out of Pocket $6,650
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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) $5,000
Out of Pocket Maximum (Family) $10,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $250 Copay per day
Inpatient Physician 30% 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 Data Not Available
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

Other Plans in Nebraska

Plan Medica with CHI Health Catastrophic Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica with CHI Health Silver Copay Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,000
Plan Medica with CHI Health Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica Insure Bronze HSA Plus Deductible $2,600 Coinsurance Not applicable Out of Pocket $6,650
Plan Medica Insure Bronze HSA Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Medica Insure Catastrophic Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica Insure Gold Copay Plus Deductible $1,000 Coinsurance Not applicable Out of Pocket $5,000
Plan Medica Insure Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,350
Plan Medica Insure Silver Copay Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,000
Plan Medica with CHI Health Bronze HSA Deductible $6,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Medica with CHI Health Bronze HSA Plus Deductible $2,600 Coinsurance Not applicable Out of Pocket $6,650