Harvard Pilgrim Health Care

ElevateHealth HMO Catastrophic

Plan Overview

Combined Medical and Drug Deductible
  • Individual: $8,700
  • Family: $17,400
  • Per Person: $8,700
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $8,700
  • Family: $17,400
  • Per Person: $8,700

Office Visit

Primary Doctor
  • CoPay: $40.00 Copay with deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
  • Benefit Explanation: Copay applies to the first 3 medical office visits per member. Deductible applies after the first 3 medical office visits per member.
Specialist
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Non Preferred Brand Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Generic Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Specialty Drugs
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
  • Exclusions: Specialty Drugs purchased through non-contracted or non-specialty drug pharmacies will not be covered.

Inpatient Coverage

Hospital Services
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Inpatient Services
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Urgent Care Facility
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered

Maternity

Labor and Delivery Hospital Stay
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
Pre and Postnatal Office Visit
  • CoPay: No Charge
  • CoInsurance: No Charge
  • Covered: Covered
  • Benefit Explanation: Routine Prenatal and Postnatal Care are covered in full.

Vision

Routine Eye Exams For Children
  • CoPay: No Charge after deductible
  • CoInsurance: No Charge after deductible
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Exam(s) per Year
  • Benefit Explanation: For Members under the age of 19

Major Dental Care

Routine Dental Checkups for Children
  • Covered: Not Covered
Routine Dental Checkups for Adults
  • Covered: Not Covered
Basic Dental Care - Adult
  • Covered: Not Covered
Basic Dental Care - Child
  • Covered: Not Covered
Major Dental Care - Adult
  • Covered: Not Covered
Major Dental Care - Child
  • Covered: Not Covered
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© 2024 HealthMarkets Insurance Agency. All rights reserved.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

HMPLAN59025NH0370047ACA1

© 2024 HealthMarkets Insurance Agency. All rights reserved.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

HMPLAN59025NH0370047ACA1

© 2024 HealthMarkets Insurance Agency. All rights reserved.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency nationwide except in MA. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

HMPLAN59025NH0370047ACA1