Modified health plans
2020 ACA Plan Comparison Guide for Small Groups | Iowa
Modified plans offer an easier approach to understanding cost-shares with a more traditional product design. These plans provide a simple approach by eliminating coinsurance — often cited as the most confusing aspect of health insurance.
Modified health plan options
Modified health plans offer protection from high-cost, catastrophic medical expenses like a hospital stay, while still offering simple copays for the most common services like office visits.
Regardless of the network you choose, all the products below are available. Amounts in the table reflect covered in-network services only. For PPO and POS plans, additional cost-shares will apply to out-of-network services.
All plans use Blue Rx EssentialsSM pharmacy benefits.
|Plan Details||SimplyBlueSM Modified (Bronze)||CompleteBlueSM Modified (Silver)||EnhancedBlueSM Modified (Gold)|
|Annual benefit — deductible/out-of-pocket maximum (opm) In-network1|
|Single out-of-pocket maximum||$8,150||$7,500
|Family2 out-of-pocket maximum||$16,300||$15,000||$9,000|
|Coinsurance — member pays||0%||0%||0%|
|Primary care office services5||$75||$50||$30|
|Non-primary care office services||$150||$100||$60|
|Prescription drugs - Blue Rx Essentials|
|Tier 2||All other tiers: annual benefit applies||$80||$50|
|Medicare Part D Creditable Coverage6||No||Yes||Yes|
Your employees will be required to use Blue Distinction® Centers for knee and hip replacements, bariatric surgery, and transplants in 2020.