{"state":{"code":"SC","name":"South Carolina","fips":45,"exchangeName":["Healthcare.gov"],"exchangeUrl":["http:\/\/www.healthcare.gov"],"exchangeType":["Federal"]},"year":"2018","plan":{"name":"Blue - BlueEssentials Gold 1","planType":"EPO","tier":"Gold","oopm":"4500.00","deductible":"2000.00","redirectUrl":"https:\/\/www.healthcare.gov"},"phoneNum":"8558665590"}
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) | $2,000 |
|---|---|
| Deductible (Family) | $4,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $4,500 |
| Out of Pocket Maximum (Family) | $9,000 |
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 | $300 Copay after deductible + 20% Coinsurance 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 | Not available |
|---|---|
| Depression | Not available |
| Diabetes | Not available |
| Heart Disease | Not available |
| High Blood Pressure / High Cholesterol | Not available |
| Lower Back Pain | Not available |
| Pain Management | Not available |
| Pregnancy | Not available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | 20% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 20% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 20% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 20% Coinsurance after deductible |
| 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 |
Other Plans in South Carolina
| Plan BlueEssentials Gold 2 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan BlueEssentials HD Silver 5 | Deductible $3,300 | Coinsurance Not applicable | Out of Pocket $5,000 |
| Plan BlueEssentials HD Silver 13 | Deductible $4,550 | Coinsurance Not applicable | Out of Pocket $4,550 |
| Plan BlueEssentials Silver 8 | Deductible $5,250 | Coinsurance Not applicable | Out of Pocket $6,700 |
| Plan BlueEssentials Silver 14 | Deductible $6,650 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueEssentials Silver 9 | Deductible $5,000 | Coinsurance Not applicable | Out of Pocket $6,850 |
| Plan BlueEssentials HD Silver 6 | Deductible $4,300 | Coinsurance Not applicable | Out of Pocket $4,300 |
| Plan BlueEssentials HD Bronze 2 | Deductible $6,300 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BlueEssentials Catastrophic 1 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan BlueEssentials Silver 1 | Deductible $690 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan BlueEssentials Silver 11 | Deductible $5,500 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueEssentials Silver 3 | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $6,500 |
| Plan BlueEssentials Bronze 4 | Deductible $6,200 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueEssentials HD Gold 3 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $2,700 |
| Plan BlueEssentials Gold 4 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $5,600 |
| Plan BlueEssentials Silver 7 | Deductible $6,400 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueEssentials Silver 12 | Deductible $4,800 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan BlueEssentials HD Bronze 5 | Deductible $6,550 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BlueEssentials Silver 4 | Deductible $3,100 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan BlueEssentials HD Bronze 3 | Deductible $5,200 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan BlueEssentials Bronze 1 | Deductible $7,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan BlueEssentials Silver 10 | Deductible $7,150 | Coinsurance Not applicable | Out of Pocket $7,150 |
| Plan BlueEssentials Silver 2 | Deductible $3,000 | Coinsurance Not applicable | Out of Pocket $6,600 |