Avera - Avera 2750

South Dakota, 2019

  • Plan Type

    PPO

  • Metal Tier

    Silver

  • Out of Pocket Maximum

    $7,100

  • Deductible

    $2,750

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) $2,750
Deductible (Family) $5,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,100
Out of Pocket Maximum (Family) $14,200

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $1,400
Deductible (Family) $2,800
Out of Pocket Maximum (Individual) $6,000
Out of Pocket Maximum (Family) $12,000

Doctor Visits

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

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $550
Deductible (Family) $1,100
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

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

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $600
Out of Pocket Maximum (Family) $1,200

Doctor Visits

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

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in South Dakota

Plan Avera 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Avera 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Avera Preferred 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,500
Plan Avera 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,500
Plan Avera Preferred 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Avera 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $6,750
Plan Avera 1500 Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,500
Plan Avera 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Avera Preferred 2750 Deductible $2,750 Coinsurance Not applicable Out of Pocket $7,100
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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) $2,750
Deductible (Family) $5,500
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,100
Out of Pocket Maximum (Family) $14,200

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $1,400
Deductible (Family) $2,800
Out of Pocket Maximum (Individual) $6,000
Out of Pocket Maximum (Family) $12,000

Doctor Visits

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

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $550
Deductible (Family) $1,100
Out of Pocket Maximum (Individual) $1,500
Out of Pocket Maximum (Family) $3,000

Doctor Visits

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

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% 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) $200
Deductible (Family) $400
Out of Pocket Maximum (Individual) $600
Out of Pocket Maximum (Family) $1,200

Doctor Visits

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

Prescription Drugs

Generic Rx 30% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 30% Coinsurance after deductible
Specialty Drugs 30% Coinsurance after deductible

Other Plans in South Dakota

Plan Avera 4000 Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,000
Plan Avera 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Avera Preferred 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,500
Plan Avera 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,500
Plan Avera Preferred 5500 Deductible $5,500 Coinsurance Not applicable Out of Pocket $7,900
Plan Avera 6750 Deductible $6,750 Coinsurance Not applicable Out of Pocket $6,750
Plan Avera 1500 Deductible $1,500 Coinsurance Not applicable Out of Pocket $3,500
Plan Avera 7900 Deductible $7,900 Coinsurance Not applicable Out of Pocket $7,900
Plan Avera Preferred 2750 Deductible $2,750 Coinsurance Not applicable Out of Pocket $7,100