Celtic - Ambetter Secure Care 1 (2019) with 3 Free PCP Visits

Indiana, 2019

  • Plan Type

    EPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $6,350

  • 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) $2,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctor Visits

Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $250 Copay 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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain 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 $25 Copay after deductible
Non Preferred Brand Rx $75 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Indiana

Plan Ambetter Balanced Care 5 (2019) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Ambetter Balanced Care 1 (2019) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2019) Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) + Vision Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 4 (2019) Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Essential Care 2 HSA (2019) Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Ambetter Balanced Care 11 (2019) Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Balanced Care 2 (2019) + Vision + Adult Dental Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2019) + Vision Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
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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) $2,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctor Visits

Primary Care Visit 20% Coinsurance after deductible
Specialist Visit 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Emergency Room Services $250 Copay 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 Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain 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 $25 Copay after deductible
Non Preferred Brand Rx $75 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in Indiana

Plan Ambetter Balanced Care 5 (2019) Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan Ambetter Balanced Care 1 (2019) + Vision + Adult Dental Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2019) Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 1 (2019) + Vision Deductible $5,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 4 (2019) Deductible $7,050 Coinsurance Not applicable Out of Pocket $7,050
Plan Ambetter Essential Care 2 HSA (2019) Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Ambetter Balanced Care 11 (2019) Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,900
Plan Ambetter Balanced Care 2 (2019) + Vision + Adult Dental Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Ambetter Balanced Care 2 (2019) + Vision Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500