Harvard Pilgrim Health Care

HMO Catastrophic 8700 Clear Choice

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

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: $50.00 Copay with deductible
CoInsurance: No Charge after deductible
Covered: Covered
Benefit Explanation: No cost sharing applies for the first non-routine office visit with a Primary Care Provider. Copay applies to the second and third medical office visit with a Primary Care Provider per member. Deductible applies after the first 3 medical office visits with a Primary Care Provider 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 a 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

Related Articles

You may be interested in these relevant articles from across the HealthMarkets.com network.

What’s the difference between an orthodontist and an endodontist?

Checking in with your family dentist is a good first step to maintaining good…Read More

Read More

Heat Stroke And Heat Exhaustion: Hot-Weather Tips to Stay Safe

Warm-summer days, lots of sun, and outdoor activities can be fun. But when the…Read More

Read More

Accidents Happen. Are You Covered?

You may think that accident insurance is only for people who like extreme sports…Read More

Read More