Medica - Harmony by Medica Silver Copay

Oklahoma, 2019

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,600

  • Deductible

    $3,700

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) $3,700
Deductible (Family) $11,100
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,600
Out of Pocket Maximum (Family) $15,200

Doctor Visits

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

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 60% Coinsurance after deductible
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) $2,500
Deductible (Family) $7,500
Out of Pocket Maximum (Individual) $5,850
Out of Pocket Maximum (Family) $11,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 50% Coinsurance after deductible
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) $500
Deductible (Family) $1,500
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
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) $100
Deductible (Family) $300
Out of Pocket Maximum (Individual) $650
Out of Pocket Maximum (Family) $1,300

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 5% Coinsurance after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs

Other Plans in Oklahoma

Plan Harmony by Medica Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Medica Quest Bronze H S A Plus Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,750
Plan Medica Quest Bronze H S A Deductible $6,200 Coinsurance Not applicable Out of Pocket $6,750
Plan Medica Quest Gold Share Deductible $500 Coinsurance Not applicable Out of Pocket $6,500
Plan Harmony by Medica Catastrophic Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Medica Quest Bronze Copay Deductible $6,850 Coinsurance Not applicable Out of Pocket $7,900
Plan Medica Quest Silver Copay Deductible $3,700 Coinsurance Not applicable Out of Pocket $7,600
Plan Harmony by Medica Bronze H S A Deductible $6,200 Coinsurance Not applicable Out of Pocket $6,750
Plan Harmony by Medica Gold Share Deductible $500 Coinsurance Not applicable Out of Pocket $6,500
Plan Harmony by Medica Bronze H S A Plus Deductible $3,100 Coinsurance Not applicable Out of Pocket $6,750
Plan Medica Quest 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) $3,700
Deductible (Family) $11,100
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,600
Out of Pocket Maximum (Family) $15,200

Doctor Visits

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

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 40% Coinsurance after deductible
Laboratory Outpatient and Professional Services 40% Coinsurance after deductible
X-Ray and Diagnostic Imaging 40% 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 40% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 40% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 40% Coinsurance after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx 60% Coinsurance after deductible
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) $2,500
Deductible (Family) $7,500
Out of Pocket Maximum (Individual) $5,850
Out of Pocket Maximum (Family) $11,700

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 50% Coinsurance after deductible
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) $500
Deductible (Family) $1,500
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 40% Coinsurance after deductible
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) $100
Deductible (Family) $300
Out of Pocket Maximum (Individual) $650
Out of Pocket Maximum (Family) $1,300

Doctor Visits

Primary Care Physician
Specialists
Emergency Room 5% Coinsurance after deductible
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx 25% Coinsurance after deductible
Specialty Drugs

Other Plans in Oklahoma

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