| Network | PPO |
| Exchange | |
| Metal Tier | Silver |
| Monthly premium | Get Price |
| Annual Deductible - Individual | $3,000.00 |
| Annual Deductible - Family | $6,000.00 |
| Coinsurance | 20% |
| Out-of-pocket Limit - Individual (adjust) | $6,350.00 |
| Out-of-pocket Limit - Family (adjust) | $12,700.00 |
| Primary Doctor Office Visit | $35 copay |
| Specialist | $50 copay |
| Urgent Care | $65 copay |
You may be eligible for a cost-sharing reduction that can reduce out-of-pocket costs, including coinsurance, deductibles, copays, out-of-pocket limit, or any combination. These reductions help you to afford the care you need. You have to purchase a Silver-level plan on the Health Insurance Marketplace to receive the reductions. No additional applications are necessary.
The plan deductible is $3,000.00 Individual / $6,000.00 Family. This means that you would need to spend $3,000.00 / $6,000.00 in medical services, like lab work and outpatient surgery.
The plan coinsurance is 20%. So if you had an outpatient surgery that cost $1,000, you would pay $200.00 of that cost. HAP would pick up the rest.
All of your copays, deductible and coinsurance payments roll up to your out-of-pocket limit. So for an individual the most you would have to pay is $6,350.00 and for a family the most you would have to pay is $12,700.00
Preventive care coverage is an Essential Health Benefit and fully covered in all of HAPs plans. Preventive care visits like a yearly physical or a yearly visit to the OB/GYN are always free.
| Periodic Health Exam/Immunizations | Covered |
| Well Baby Care | Covered |
| Routine Eye Exam | Covered |
| Routine Hearing Exams | Covered |
| Preventive Related Lab Tests and X-rays | Covered |
| Periodic OB/GYN | Covered |
| Outpatient Lab/X-Ray | $50 copay |
| Outpatient Surgery | Subject to deductible and coinsurance |
| Emergency Room | $250 copay |
| Inpatient Services | Subject to deductible and coinsurance |
| Prenatal Office Visit | Covered |
| Postnatal Office Visit | $50 copay |
| Labor and Delivery | Subject to deductible and coinsurance |
| Mental Health - Outpatient | $35 copay |
| Substance Abuse - Outpatient | $35 copay |
Dental Coverage is not part of your Personal Alliance plan. However, separate Dental coverage is available on the Health Insurance Marketplace.
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No need to worry, HAP has our member's vision benefits covered! Adult vision hardware is covered along with pediatric vision hardware in all 2014 HAP health plans. Pediatric vision care is an Essential Health Benefit. Pediatric is defined as those members under 19 years of age.
Included vision benefits
| Generic Copay | $10.00 |
| Preferred Brand Copay | $60.00 |
| Non Preferred Brand Copay | 50% |
| Specialty Copay | 50% |
| Annual Deductible - Individual | $6,000.00 |
| Annual Deductible - Family | $12,000.00 |
| Coinsurance | 50% |
| Out-of-pocket Limit - Individual | $12,000.00 |
| Out-of-pocket Limit - Family | $24,000.00 |
If you have any questions, please call a HAP Sales Representative at (855) WITH-HAP between 8 a.m. - 6 p.m. EST Mon - Fri for one-on-one assistance. Prefer email?
Representatives are also available at the following locations to provide a private consultation and answer your health insurance questions with on-the-spot enrollment assistance.
