Medica - Select by Medica Gold Copay

Missouri, 2019

  • Plan Type

    EPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $6,500

  • Deductible

    $750

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) $750
Deductible (Family) $2,250
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,500
Out of Pocket Maximum (Family) $13,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% 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 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% 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

Other Plans in Missouri

Plan Select by Medica Bronze H S A Plus Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,750
Plan Select by Medica Gold Share Deductible $500 Coinsurance Not applicable Out of Pocket $6,500
Plan Select by Medica Bronze H S A Deductible $6,200 Coinsurance Not applicable Out of Pocket $6,750
Plan Select by Medica Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Select by Medica Silver Copay Deductible $3,700 Coinsurance Not applicable Out of Pocket $7,600
Plan Select by Medica Bronze Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
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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) $750
Deductible (Family) $2,250
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,500
Out of Pocket Maximum (Family) $13,000

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% 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 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% 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

Other Plans in Missouri

Plan Select by Medica Bronze H S A Plus Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,750
Plan Select by Medica Gold Share Deductible $500 Coinsurance Not applicable Out of Pocket $6,500
Plan Select by Medica Bronze H S A Deductible $6,200 Coinsurance Not applicable Out of Pocket $6,750
Plan Select by Medica Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Select by Medica Silver Copay Deductible $3,700 Coinsurance Not applicable Out of Pocket $7,600
Plan Select by Medica Bronze Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900