First - my Priority Blue Flex HMO Silver 4550 HSA

Pennsylvania, 2019

  • Plan Type

    HMO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $6,650

  • Deductible

    $4,450

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) $4,450
Deductible (Family) $8,900
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,650
Out of Pocket Maximum (Family) $13,300

Doctor Visits

Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% 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 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

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) $2,550
Deductible (Family) $5,100
Out of Pocket Maximum (Individual) $4,850
Out of Pocket Maximum (Family) $9,700

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

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) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $2,200
Out of Pocket Maximum (Family) $4,400

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

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) $200
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

Other Plans in Pennsylvania

Plan my Priority Blue Major Events HMO 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan my Priority Blue Flex HMO Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
Plan my Priority Blue Flex HMO Silver 2100 - 2 Free PCP Visits Deductible $2,100 Coinsurance Not applicable Out of Pocket $7,800
Plan my Lehigh Valley Flex Blue HMO Gold 800 - 2 Free PCP Visit Deductible $800 Coinsurance Not applicable Out of Pocket $7,000
Plan my Priority Blue Flex HMO Silver 0 Deductible $0 Coinsurance Not applicable Out of Pocket $7,800
Plan my Priority Blue Flex HMO Bronze 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan my Priority Blue Flex HMO Bronze 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan my Lehigh Valley Flex Blue HMO Silver 1900 - 2 Free PCP Visits Deductible $1,900 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) $4,450
Deductible (Family) $8,900
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $6,650
Out of Pocket Maximum (Family) $13,300

Doctor Visits

Primary Care Visit 10% Coinsurance after deductible
Specialist Visit 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Emergency Room Services 10% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 10% Coinsurance after deductible
Laboratory Outpatient and Professional Services 10% Coinsurance after deductible
X-Ray and Diagnostic Imaging 10% 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 10% Coinsurance after deductible
Mental / Behavioral Health Outpatient 10% Coinsurance after deductible
Rehabilitative Speech Therapy 10% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 10% Coinsurance after deductible
Outpatient Facility 10% Coinsurance after deductible
Outpatient Surgery 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

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) $2,550
Deductible (Family) $5,100
Out of Pocket Maximum (Individual) $4,850
Out of Pocket Maximum (Family) $9,700

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

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) $600
Deductible (Family) $1,200
Out of Pocket Maximum (Individual) $2,200
Out of Pocket Maximum (Family) $4,400

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

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) $200
Out of Pocket Maximum (Individual) $1,000
Out of Pocket Maximum (Family) $2,000

Doctor Visits

Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room 10% Coinsurance after deductible
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible

Prescription Drugs

Generic Rx 10% Coinsurance after deductible
Preferred Brand Rx 10% Coinsurance after deductible
Non Preferred Brand Rx 10% Coinsurance after deductible
Specialty Drugs 10% Coinsurance after deductible

Other Plans in Pennsylvania

Plan my Priority Blue Major Events HMO 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan my Priority Blue Flex HMO Gold 1000 - 2 Free PCP Visits Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,000
Plan my Priority Blue Flex HMO Silver 2100 - 2 Free PCP Visits Deductible $2,100 Coinsurance Not applicable Out of Pocket $7,800
Plan my Lehigh Valley Flex Blue HMO Gold 800 - 2 Free PCP Visit Deductible $800 Coinsurance Not applicable Out of Pocket $7,000
Plan my Priority Blue Flex HMO Silver 0 Deductible $0 Coinsurance Not applicable Out of Pocket $7,800
Plan my Priority Blue Flex HMO Bronze 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan my Priority Blue Flex HMO Bronze 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $7,900
Plan my Lehigh Valley Flex Blue HMO Silver 1900 - 2 Free PCP Visits Deductible $1,900 Coinsurance Not applicable Out of Pocket $7,900