Harvard - HMO Gold 1500

Maine, 2019

  • Plan Type

    HMO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $5,250

  • 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) $5,250
Out of Pocket Maximum (Family) $10,500

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit 25% Coinsurance after deductible
Inpatient Facility 25% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 25% Coinsurance after deductible
Laboratory Outpatient and Professional Services 25% Coinsurance after deductible
X-Ray and Diagnostic Imaging 25% 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 Available

Other

Mental / Behavioral Health Inpatient 25% Coinsurance after deductible
Mental / Behavioral Health Outpatient 25% Coinsurance after deductible
Rehabilitative Speech Therapy 25% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 25% Coinsurance after deductible
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Maine

Plan HMO Silver 2500 Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,900
Plan HMO HSA Bronze 5400 Deductible $5,400 Coinsurance Not applicable Out of Pocket $6,650
Plan HMO Bronze 6500 Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Maines Choice HMO Silver 2500 Casco Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,000
Plan Maines Choice HMO HSA Bronze 5000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Maines Choice HMO Silver 4500 Pemaquid Deductible $4,500 Coinsurance Not applicable Out of Pocket $7,000
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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) $5,250
Out of Pocket Maximum (Family) $10,500

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit 25% Coinsurance after deductible
Inpatient Facility 25% Coinsurance after deductible
Inpatient Physician 25% Coinsurance after deductible
Emergency Room Services 40% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 25% Coinsurance after deductible
Laboratory Outpatient and Professional Services 25% Coinsurance after deductible
X-Ray and Diagnostic Imaging 25% 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 Available

Other

Mental / Behavioral Health Inpatient 25% Coinsurance after deductible
Mental / Behavioral Health Outpatient 25% Coinsurance after deductible
Rehabilitative Speech Therapy 25% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 25% Coinsurance after deductible
Outpatient Facility 25% Coinsurance after deductible
Outpatient Surgery 25% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 50% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Maine

Plan HMO Silver 2500 Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,900
Plan HMO HSA Bronze 5400 Deductible $5,400 Coinsurance Not applicable Out of Pocket $6,650
Plan HMO Bronze 6500 Deductible $6,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Maines Choice HMO Silver 2500 Casco Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,000
Plan Maines Choice HMO HSA Bronze 5000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,650
Plan Maines Choice HMO Silver 4500 Pemaquid Deductible $4,500 Coinsurance Not applicable Out of Pocket $7,000