Out of Pocket Calculator Help

HMO Low Benefit

HMO Low Benefit is one of the models to select from in the Select a Plan Model portion of the Plan Information section in the General Plan Information Sheet. “HMO” refers to a “Health Maintenance Organization” type of health plan. The HMO Low Benefit model assumes the following default benefit features:

General Individual Deductible: $100
General Family Deductible: $250
Inpatient Deductible Per Admission- Participating Hospitals: $750
Inpatient Deductible Per Admission- Non-Participating Hospitals: NA
Coinsurance- Participating Hospitals: 20%
Coinsurance- Non-Participating Hospitals: NA
Maximum Allowable Per Day- Non Participating Hospitals: NA
Maximum Individual Annual Out of Pocket – Participating Providers: $3,000
Maximum Individual Annual Out of Pocket – Non Participating: NA
Maximum Family Annual Out of Pocket – Participating Providers: $6,000
Maximum Family Annual Out of Pocket – Non Participating: NA