Keystone - Keystone HMO Silver Proactive

Pennsylvania, 2019

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $0

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) $0
Deductible (Family) $0
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 $500 Copay per day
Inpatient Physician No charge
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services No charge
X-Ray and Diagnostic Imaging Data Not Available

Health Management Programs

Asthma Available
Depression Not 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 $500 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery Data Not Available

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $500 Copay per day
Inpatient Physician No charge

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $100 Copay per day
Inpatient Physician No charge

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,200
Out of Pocket Maximum (Family) $2,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $75 Copay per day
Inpatient Physician No charge

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan Keystone HMO Platinum Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan Keystone HMO Gold Deductible $0 Coinsurance Not applicable Out of Pocket $6,500
Plan Keystone HMO Gold Proactive Deductible $0 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) $0
Deductible (Family) $0
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 $500 Copay per day
Inpatient Physician No charge
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services No charge
X-Ray and Diagnostic Imaging Data Not Available

Health Management Programs

Asthma Available
Depression Not 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 $500 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery Data Not Available

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $6,300
Out of Pocket Maximum (Family) $12,600

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $500 Copay per day
Inpatient Physician No charge

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $2,600
Out of Pocket Maximum (Family) $5,200

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $100 Copay per day
Inpatient Physician No charge

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) $0
Deductible (Family) $0
Out of Pocket Maximum (Individual) $1,200
Out of Pocket Maximum (Family) $2,400

Doctor Visits

Primary Care Physician
Specialists
Emergency Room
Inpatient Facility $75 Copay per day
Inpatient Physician No charge

Prescription Drugs

Generic Rx
Preferred Brand Rx
Non Preferred Brand Rx
Specialty Drugs

Other Plans in Pennsylvania

Plan Keystone HMO Platinum Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan Keystone HMO Gold Deductible $0 Coinsurance Not applicable Out of Pocket $6,500
Plan Keystone HMO Gold Proactive Deductible $0 Coinsurance Not applicable Out of Pocket $7,900