Harvard - ElevateHealth HMO Silver 3500

New Hampshire, 2019

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $3,500

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) $3,500
Deductible (Family) $7,000
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 $1000 Copay per stay after deductible
Inpatient Physician No charge after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
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 Available

Other

Mental / Behavioral Health Inpatient $1000 Copay per stay after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility $150 Copay after deductible
Outpatient Surgery $150 Copay after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $3,500
Deductible (Family) $7,000
Out of Pocket Maximum (Individual) $5,500
Out of Pocket Maximum (Family) $11,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $500 Copay after deductible
Inpatient Facility $1000 Copay per stay after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $950
Deductible (Family) $1,900
Out of Pocket Maximum (Individual) $2,500
Out of Pocket Maximum (Family) $5,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $300 Copay after deductible
Inpatient Facility $500 Copay per stay after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $475
Deductible (Family) $950
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility $150 Copay per stay after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in New Hampshire

Plan ElevateHealth HMO Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan ElevateHealth HMO Silver 5000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan ElevateHealth HMO Gold 1500 Deductible $1,500 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) $3,500
Deductible (Family) $7,000
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 $1000 Copay per stay after deductible
Inpatient Physician No charge after deductible
Emergency Room Services $500 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
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 Available

Other

Mental / Behavioral Health Inpatient $1000 Copay per stay after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility $150 Copay after deductible
Outpatient Surgery $150 Copay after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $3,500
Deductible (Family) $7,000
Out of Pocket Maximum (Individual) $5,500
Out of Pocket Maximum (Family) $11,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $500 Copay after deductible
Inpatient Facility $1000 Copay per stay after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $950
Deductible (Family) $1,900
Out of Pocket Maximum (Individual) $2,500
Out of Pocket Maximum (Family) $5,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $300 Copay after deductible
Inpatient Facility $500 Copay per stay after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing

Deductible (Individual) $475
Deductible (Family) $950
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room $150 Copay after deductible
Inpatient Facility $150 Copay per stay after deductible
Inpatient Physician No charge after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in New Hampshire

Plan ElevateHealth HMO Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan ElevateHealth HMO Silver 5000 Deductible $5,000 Coinsurance Not applicable Out of Pocket $7,900
Plan ElevateHealth HMO Gold 1500 Deductible $1,500 Coinsurance Not applicable Out of Pocket $7,900