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) |
$6,850 |
Deductible (Family) |
$13,700 |
Coinsurance |
Not applicable |
Out of Pocket Maximum (Individual) |
$7,900 |
Out of Pocket Maximum (Family) |
$15,800 |
Doctor Visits
Primary Care Visit |
Data Not Available |
Specialist Visit |
Data Not Available |
Inpatient Facility |
50% Coinsurance after deductible |
Inpatient Physician |
50% Coinsurance after deductible |
Emergency Room Services |
50% Coinsurance after deductible |
Tests and Imaging
Imaging (CT/PET Scans, MRIs) |
50% Coinsurance after deductible |
Laboratory Outpatient and Professional Services |
50% Coinsurance after deductible |
X-Ray and Diagnostic Imaging |
50% 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 |
50% Coinsurance after deductible |
Mental / Behavioral Health Outpatient |
Data Not Available |
Rehabilitative Speech Therapy |
50% Coinsurance after deductible |
Rehabilitative Occupational & Physical Therapy |
50% Coinsurance after deductible |
Outpatient Facility |
50% Coinsurance after deductible |
Outpatient Surgery |
50% Coinsurance after deductible |
Prescription Drugs
Generic Rx |
Data Not Available |
Preferred Brand Rx |
Data Not Available |
Non Preferred Brand Rx |
70% Coinsurance after deductible |
Specialty Drugs
| |
Other Plans in North Dakota
Plan
Altru Prime by Medica Gold Copay
|
Deductible
$750 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Medica Individual Choice Bronze HSA Plus
|
Deductible
$3,100 |
Coinsurance Not applicable |
Out of Pocket
$6,750 |
Plan
Medica Individual Choice Bronze HSA
|
Deductible
$6,200 |
Coinsurance Not applicable |
Out of Pocket
$6,750 |
Plan
Altru Prime by Medica Bronze H S A
|
Deductible
$6,200 |
Coinsurance Not applicable |
Out of Pocket
$6,750 |
Plan
Altru Prime by Medica Bronze H S A Plus
|
Deductible
$3,100 |
Coinsurance Not applicable |
Out of Pocket
$6,750 |
Plan
Medica Individual Choice Gold Copay
|
Deductible
$750 |
Coinsurance Not applicable |
Out of Pocket
$6,500 |
Plan
Medica Individual Choice Bronze Copay
|
Deductible
$6,850 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Medica Individual Choice Silver Copay
|
Deductible
$3,700 |
Coinsurance Not applicable |
Out of Pocket
$7,600 |
Plan
Altru Prime by Medica Catastrophic
|
Deductible
$7,900 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Medica Individual Choice Catastophic
|
Deductible
$7,900 |
Coinsurance Not applicable |
Out of Pocket
$7,900 |
Plan
Altru Prime by Medica Silver Copay
|
Deductible
$3,700 |
Coinsurance Not applicable |
Out of Pocket
$7,600 |