GoDirect Health Insurance Services

Standard Benefits

2017 Patient-Centered Benefit Designs and Medical Cost Shares

Benefits in blue are NOT subject to a deductible. Benefits in light-blue are subject to a deductible after the first three visits.

Coverage Category Minimum Coverage Bronze Silver Enhanced Silver 73 Enhanced Silver 87 Enhanced Silver 94 Gold Platinum
Percent of cost coverage Covers 0% until out-of-pocket maximum is met Covers 60% average annual cost Covers 70% average annual cost Covers 73% average annual cost Covers 87% average annual cost Covers 94% average annual cost Covers 80% average annual cost Covers 90% average annual cost
Cost-sharing Reduction Single Income Range N/A N/A N/A $23,451 to $29,425
(>200% to <= 250% FPL)
$17,656 to $23,450
(>150% to <= 200% FPL)
up to $17,655
(>100% to <= 150% FPL)
N/A N/A
Annual Wellness Exam $0 $0 $0 $0 $0 $0 $0 $0
Primary Care Visit after first 3 non-preventive visits, pay negotiated carrier rate per instance until out-of-pocket maximum is met $75* $35 $30 $10 $5 $30 $15
Urgent Care $75* $35 $30 $10 $5 $30 $15
Specialist Visit pay negotiated carrier rate per service until out-of-pocket maximum is met $105* $70 $55 $25 $8 $55 $40
Laboratory Tests $40 $35 $35 $15 $8 $35 $20
X-Rays and Diagnostics Full cost until deductible is met $70 $65 $25 $8 $55 $40
Imaging $300 $300 $100 $50 $275 copay
20% coinsurance***
$150 copay
10% coinsurance***
Tier 1 (Generic Drugs) pay negotiated carrier rate per script until out-of-pocket maximum is met Full cost up to $500 after drug deductible is met $15 $15 $5 $3 $15 $5
Tier 2 (Preferred Drugs) $55** $50** $20** $10 $55 or less $15 or less
Tier 3 (Non-preferred Drugs) $80** $75** $35** $15 $75 or less $25 of less
Tier 4 (Specialty Drugs) 20% up to $250**
per script
20% up to $250**
per script
15% up to $150**
per script
10% up to $150
per script
20% up to $250
per script
10% up to $250
per script
Medical Deductible N/A Individual: $6,300
Family: $12,600
Individual: $2,500
Family: $5,000
Individual: $2,200
Family: $4,400
Individual: $650
Family: $1,300
Individual: $75
Family: $150
N/A N/A
Pharmacy Deductible N/A Individual: $500
Family: $1,000
Individual: $250
Family: $500
Individual: $250
Family: $500
Individual: $50
Family: $100
N/A N/A N/A
Annual Out-of-Pocket Maximum $7,150
individual only
$6,800 individual
$13,600 family
$6,800 individual
$13,600 family
$5,700 individual
$11,400 family
$2,350 individual
$4,700 family
$2,350 individual
$4,700 family
$6,750 individual
$13,500 family
$4,000 individual
$8,000 family

Drug prices are for a 30 day supply.
* Copay is for any combination of services (primary care, specialist, urgent care) for the first three visits. After three visits, future visits will be at full cost until the medical deductible is met.
** Price is after pharmacy deductible is met.
*** See plan Evidence of Coverage for imaging cost share.