Medica Insure Silver Share ($0 Virtual Care + Online Wellness) (2022) - Allamakee - IA

Medica Insure Silver Share ($0 Virtual Care + Online Wellness) (2022) - Allamakee - IA

  57 InfoPreferred Score Good

specifications

  • Premium 607.29 Dollar(s)
  • Deductibles 2000 Dollar(s)
  • Out of Pocket Maximum 8700 Dollar(s)
  • Covered Benefits 30 out of 40

Key Features

$ 607.29
Premium
Average
$ 2000
Deductibles
Very Good
$ 8700
Out of Pocket Maximum
Poor
30 / 40
Covered Benefits
Good

  • Overview

    Plan ID: 93078IA0060027
    Plan Type: EPO
    Metal Level: Silver
    Covered Benefits: 30
    County: Allamakee
    FIPS County Code: 19005
    State: IA
    SM Rating: 57

  • Cost of Medical Sharing

    Premium: 607.29
    EHB Premium: 607.29
    EHB Percent of Total Premium: 100
    Deductibles: 2000
    Out of Pocket Maximum: 8700

  • Cost Sharing

    Adult Dental Care Details: Benefit Not Covered
    Child Dental Care Details: Benefit Not Covered
    Child Dental Check Up: Benefit Not Covered
    Adult Major Dental Care: Benefit Not Covered
    Child Major Dental Care: Benefit Not Covered
    Adult Routine Dental Services: Benefit Not Covered
    Eye Glasses for Children: 50% Coinsurance after deductible
    Adult Routine Eye Exam Details: Benefit Not Covered
    Child Routine Eye Exam Details: 50% Coinsurance after deductible
    Hearing Aids Details: Benefit Not Covered
    Bariatric Surgery: 50% Coinsurance after deductible
    Chemotherapy: 50% Coinsurance after deductible
    Chiropractic Care: 50% Coinsurance after deductible
    Dialysis: 50% Coinsurance after deductible
    Durable Medical Equipment: 50% Coinsurance after deductible
    Emergency Room Services: 50% Coinsurance after deductible
    Emergency Transportation Ambulance: 50% Coinsurance after deductible
    Habilitation Services: 50% Coinsurance after deductible
    Imaging (CT, Pet, MRIS Scan): 50% Coinsurance after deductible
    Infertility Treatment: 50% Coinsurance after deductible
    Inpatient Hospital Services: 50% Coinsurance after deductible
    Inpatient Physician and Surgical Services: 50% Coinsurance after deductible
    Laboratory Outpatient and Professional Services: 50% Coinsurance after deductible
    Mental Behavioral Health Inpatient Services: Not Covered
    Mental Behavioral Health Outpatient Services: 50% Coinsurance after deductible
    Adult Orthodontia: Benefit Not Covered
    Child Orthodontia: Benefit Not Covered
    Outpatient Facility Fee: 50% Coinsurance after deductible
    Outpatient Rehabilitation Services: 50% Coinsurance after deductible
    Outpatient Surgery Services: 50% Coinsurance after deductible
    Preventive Care Screening Immunization: No Charge
    Primary Care Visit: 50% Coinsurance after deductible
    Private Duty Nursing: 50% Coinsurance after deductible
    Skilled Nursing Facility: 50% Coinsurance after deductible
    Specialist Visit: 50% Coinsurance after deductible
    XRays and Diagnostic Imaging: 50% Coinsurance after deductible

  • Prescription Drug Coverage

    List of Covered Drugs URL: https://www.medica.com/RxList22
    Generic Drugs: $15
    Non Preferred Brand Drugs: 60% Coinsurance after deductible
    Preferred Brand Drugs: $120
    Specialty Drugs: $700

  • Benefits

    Dental Benefits: 0
    Vision Benefits: 2
    Hearing Benefits: 0
    Other Benefits: 28
    Adult Dental Care:
    Child Dental Care:
    Adult Routine Eye Exam:
    Child Routine Eye Exam: 1
    Hearing Aids:
    National Network Available:
    Health Savings Account Eligibility:
    Disease Management Programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure and High Cholesterol, Low Back Pain, Pain Management, Pregnancy

  • Plan Documents

    Provider Directory URL: https://www.medica.com/FindInsureProviders
    Benefits Summary URL: https://portal.medica.com/visitor/sbcsearch/docdisplay?plancode=2022-IFBISSIA&uid=FFM
    Brochure URL: https://www.medica.com/2022InsureIA

  • Policy Issuer Details

    Eligible Dependents: Self, Spouse, Child, Stepson or Stepdaughter, Grandson or Granddaughter, Life Partner, Ward
    Issuer: Medica
    Issuer ID: 93078
    Issuer Shop URL: http://www.medica.com
    Customer Service Toll free Number: 1-888-592-8211
    Area: Rating Area 7

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