CareSource - CareSource Gold Dental and Vision

West Virginia, 2018

  • Plan Type

    HMO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $5,000

  • Deductible

    $1,500

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) $1,500
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 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services 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 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 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
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 50% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in West Virginia

Plan CareSource Federal Simple Choice Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Silver Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,300
Plan CareSource Federal Simple Choice Silver Dental and Vision Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Bronze Deductible $7,250 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Low Premium Silver Dental and Vision Deductible $6,150 Coinsurance Not applicable Out of Pocket $7,300
Plan CareSource Federal Simple Choice Bronze Dental and Vision Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Gold Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,000
Plan CareSource Federal Simple Choice Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource HSA Bronze Deductible $4,000 Coinsurance Not applicable Out of Pocket $6,550
Plan CareSource Silver Dental and Vision Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,300
Plan CareSource Bronze Dental and Vision Deductible $7,250 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Low Premium Silver Deductible $6,150 Coinsurance Not applicable Out of Pocket $7,300
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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) $1,500
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 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services 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 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 20% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
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 50% Coinsurance after deductible
Specialty Drugs 40% Coinsurance after deductible

Other Plans in West Virginia

Plan CareSource Federal Simple Choice Silver Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Silver Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,300
Plan CareSource Federal Simple Choice Silver Dental and Vision Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Bronze Deductible $7,250 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Low Premium Silver Dental and Vision Deductible $6,150 Coinsurance Not applicable Out of Pocket $7,300
Plan CareSource Federal Simple Choice Bronze Dental and Vision Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Gold Deductible $1,500 Coinsurance Not applicable Out of Pocket $5,000
Plan CareSource Federal Simple Choice Bronze Deductible $6,650 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource HSA Bronze Deductible $4,000 Coinsurance Not applicable Out of Pocket $6,550
Plan CareSource Silver Dental and Vision Deductible $3,900 Coinsurance Not applicable Out of Pocket $7,300
Plan CareSource Bronze Dental and Vision Deductible $7,250 Coinsurance Not applicable Out of Pocket $7,350
Plan CareSource Low Premium Silver Deductible $6,150 Coinsurance Not applicable Out of Pocket $7,300