Non-Standard: HMO 2000 Value II - Flex
Harvard Pilgrim Health Care, Inc. · 2027 plan year
Gold
- Ind. medical deductible
- $2,000
- Rx deductible (separate)
- $250
- Family deductible
- $4,000
- Ind. OOP max
- $6,100
- Family OOP max
- $12,200
This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.
Compare with other Gold plans in MA
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More Harvard Pilgrim Health Care, Inc. plans in MA
Monthly premiums by age
Rating Area 1 — the lowest-priced of the 7 areas this plan covers. Premiums differ by area.
| Age | Individual |
|---|---|
| Under 15 | $452 |
| 21 | $712 |
| 30 | $775 |
| 40 | $839 |
| 50 | $1,048 |
| 60 | $1,424 |
| 64 and over | $1,424 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $25.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $50.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $500.00 Copay after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | $750.00 Copay per Stay after deductible |
| Outpatient Surgery Physician/Surgical Services | No Charge after deductible |
| Urgent Care Centers or Facilities | $50.00 Copay after deductible |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $30.00 |
| Non-Preferred Brand Drugs | $250.00 Copay after deductible |
| Off Label Prescription Drugs | $250.00 Copay after deductible |
| Preferred Brand Drugs | $150.00 Copay after deductible |
| Specialty Drugs | $250.00 Copay after deductible |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $750.00 Copay per Stay after deductible |
| Mental/Behavioral Health Outpatient Services | $25.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | No Charge after deductible |
| Accidental Dental | $25.00 |
| Acupuncture | $50.00 |
| Allergy Testing | $75.00 Copay after deductible |
| Bariatric Surgery | $750.00 Copay after deductible |
| Basic Dental Care - Child | No charge |
| Bone Marrow Transplants for Treatment of Breast Cancer | $750.00 Copay after deductible |
| Cardiac Rehabilitation | $50.00 |
| Chemotherapy | No Charge after deductible |
| Childbirth Classes | No charge |
| Chiropractic Care | $50.00 |
| Clinical Trials | $750.00 Copay after deductible |
| Congenital Anomaly, including Cleft Lip/Palate | $750.00 Copay after deductible |
| Contraceptive Services | No charge |
| Delivery and All Inpatient Services for Maternity Care | $750.00 Copay after deductible |
| Dental Check-Up for Children | No charge |
| Diabetes Care Management | $25.00 |
| Diabetes Education | $50.00 |
| Dialysis | No Charge after deductible |
| Durable Medical Equipment | 20.00% Coinsurance after deductible |
| Early Intervention Services | No charge |
| Emergency Transportation/Ambulance | No Charge after deductible |
| Eye Glasses for Children | 50.00% |
| Fitness Club Reimbursement | No charge |
| Gender Affirming Care | $750.00 Copay after deductible |
| Habilitation Services | $75.00 Copay after deductible |
| Hearing Aids | 20.00% Coinsurance after deductible |
| Home Health Care Services | No Charge after deductible |
| Hormone Replacement Therapy (HRT) | $25.00 |
| Hospice Services | No Charge after deductible |
| Human Leukocyte Antigen Testing | $75.00 Copay after deductible |
| Hypodermic Syringes or Needles | $150.00 Copay after deductible |
| Imaging (CT/PET Scans, MRIs) | $500.00 Copay after deductible |
| Infertility Treatment | No Charge after deductible |
| Infusion Therapy | No Charge after deductible |
| Inherited Metabolic Disorders - PKU | No Charge after deductible |
| Inpatient Physician and Surgical Services | No Charge after deductible |
| Inpatient Rehabilitation Services | $750.00 Copay after deductible |
| Laboratory Outpatient and Professional Services | $75.00 Copay after deductible |
| Low Protein Foods | No Charge after deductible |
| Major Dental Care - Child | 50.00% |
| Minor Dental Care - Child | 20.00% |
| Nutrition/Formulas | No Charge after deductible |
| Nutritional Counseling | $25.00 |
| Orthodontia - Child | 50.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $25.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $500.00 Copay after deductible |
| Outpatient Rehabilitation Services | $75.00 Copay after deductible |
| Prenatal and Postnatal Care | No charge |
| Prosthetic Devices | 20.00% Coinsurance after deductible |
| Radiation | No Charge after deductible |
| Reconstructive Surgery | $750.00 Copay after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $75.00 Copay after deductible |
| Rehabilitative Speech Therapy | $75.00 Copay after deductible |
| Retail Health Clinics | $25.00 |
| Routine Eye Exam (Adult) | $50.00 |
| Routine Eye Exam for Children | $50.00 |
| Routine Foot Care | $50.00 |
| Skilled Nursing Facility | $750.00 Copay per Stay after deductible |
| Substance Abuse Disorder Inpatient Services | $750.00 Copay per Stay after deductible |
| Substance Abuse Disorder Outpatient Services | $25.00 |
| Transplant | $750.00 Copay after deductible |
| Treatment for Temporomandibular Joint Disorders | $500.00 Copay after deductible |
| Weight Loss Programs | No charge |
| Well Baby Visits and Care | No charge |
| Wigs | 20.00% Coinsurance after deductible |
| X-rays and Diagnostic Imaging | $50.00 Copay after deductible |
Service area
This plan covers 1 geographic area.
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