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) |
$2,000 |
Coinsurance |
Not applicable |
Out of Pocket Maximum (Individual) |
$7,000 |
Out of Pocket Maximum (Family) |
$14,000 |
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 |
$500 Copay after deductible |
Tests and Imaging
Imaging (CT/PET Scans, MRIs) |
20% Coinsurance after deductible |
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 |
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 |
Data Not Available |
Specialty Drugs
| |
Other Plans in Delaware
Plan
Major Events Blue EPO 7900
|
Deductible
$7,900 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Health Savings Embedded Blue EPO Silver 4450 HSA
|
Deductible
$4,450 |
Coinsurance Not applicable |
Out of Pocket
$6,650 |
Plan
Shared Cost Blue EPO Bronze 4000
|
Deductible
$4,000 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Shared Cost Blue EPO Silver 0
|
Deductible
$0 |
Coinsurance Not applicable |
Out of Pocket
$7,800 |
Plan
Shared Cost Blue EPO Bronze 7900
|
Deductible
$7,900 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Shared Cost Blue EPO Silver 2400 - 2 Free PCP Visits
|
Deductible
$2,400 |
Coinsurance Not applicable |
Out of Pocket
$7,800 |
Plan
Shared Cost Blue EPO Platinum 200 - 2 Free PCP Visits
|
Deductible
$200 |
Coinsurance Not applicable |
Out of Pocket
$6,000 |