AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards

72760DE0010003
Silver
HMO

AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards is a Silver HMO plan by AmeriHealth Caritas Next.

IMPORTANT: You are viewing the 2023 version of AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards 72760DE0010003. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards is offered in the following counties.

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Plan Overview

This is a plan overview for 2023 version of AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards 72760DE0010003.
Insurer: AmeriHealth Caritas Next
Network Type: HMO
Metal Type: Silver
HSA Eligible?: No
Plan ID: 72760DE0010003

Cost-Sharing Overview

AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Diabetes, Pregnancy, Weight Loss Programs
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: No
Out of Service Area Coverage Description:
National Network: No

Additional Benefits and Cost-Sharing

AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$40.00 100.00%
Specialist Visit
Covered
$80.00 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$40.00 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
40.00% Coinsurance after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
40.00% Coinsurance after deductible 100.00%
Hospice Services
Covered
40.00% Coinsurance after deductible 100.00% Private duty nursing; respite care; care not prescribed in the approved treatment plan; financial, legal, or estate planning, and; hospice care in an acute care facility, except when a patient in hospice care requires services in an inpatient setting for a limited time
Routine Dental Services (Adult)
Infertility Treatment
Covered
40.00% Coinsurance after deductible 100.00%6 Procedure(s) per Lifetime For IVF services, retrievals must be completed before the individual is 45 years old and transfers must be completed before the individual is 50 years old. The benefit is limited to six (6) completed egg retrievals per lifetime, with unlimited embryo transfers in accordance with the guidelines of the American Society for Reproductive Medicine, using single embryo transfer (SET) when recommended and medically appropriate. We will cover services for the diagnosis, treatment, and correction of any underlying causes of infertility when determined to be medically necessary by a network provider. This includes coverage of certain prescription drugs, in vitro fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer (ZIFT), and standard fertility preservation services for covered persons who must undergo medically necessary treatment that may cause iatrogenic infertility.
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Covered
40.00% Coinsurance after deductible 100.00%240 Hours per Benefit Period This care isn’t covered when done in special care units of the hospital, such as: self-care units; selective care units; intensive care units. Covered health services under this section include medically necessary nursing care provided to a patient one on one by licensed nurses in an inpatient or home setting. Private duty nursing care is covered when you are an inpatient in an acute hospital. This care isn’t covered when done in special care units of the hospital such as: -self-care units -selective care units -intensive care units Inpatient private duty nursing care is not covered when done as a convenience even if authorized by your doctor.
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$60.00 100.00%
Home Health Care Services
Covered
40.00% Coinsurance after deductible 100.00%100 Visit(s) per Benefit Period Chronic condition care is not covered; drugs; lab tests; imaging services; inhalation therapy; chemotherapy and radiation therapy; dietary care; durable medical equipment; disposable supplies; care not prescribed in the approved treatment plan; volunteer care. We will cover certain services received in the home from a certified/licensed home health agency when ordered by a physician. Examples of these services include skilled care, physical/ occupational/speech and language/respiratory therapy, social work services, and home infusion. Services must only be provided on a part-time, intermittent basis and cannot be solely for assisting with activities of daily living. There’s a limit of one visit per day per specialty. (A nurse and home health aide count as one specialty for this benefit.)
Emergency Room Services
Covered
40.00% Coinsurance after deductible 40.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
40.00% Coinsurance after deductible 40.00% Coinsurance after deductible We cover ambulance services (including voluntary services) by ground, air, or water in the event of an emergency. Services must be provided by a licensed ambulance, including volunteer, service provider and must take you to the nearest hospital where emergency care can be provided. Air Ambulance is covered only when no other means of travel is appropriate. We also cover nonemergency ambulance transportation by a licensed ambulance service (either ground, air, or water ambulance) when the transport is: ? From an acute facility to a subacute facility/setting. ? From an out-of-network hospital/facility to an in-network hospital/facility. ? To a hospital that provides a higher level of care than was available at the original hospital/facility. ? To a more cost-effective acute care facility.
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
40.00% Coinsurance after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
40.00% Coinsurance after deductible 100.00%
Bariatric Surgery
Covered
40.00% Coinsurance after deductible 100.00%
Cosmetic Surgery
Skilled Nursing Facility
Covered
40.00% Coinsurance after deductible 100.00%120 Days per Admission Covered health services do not include custodial, domiciliary care, or long-term care admissions. The skilled nursing facility is a Network Provider. Coverage is limited to 120 days per confinement. A confinement includes all admissions not separated by 180 days.
Prenatal and Postnatal Care
Covered
40.00% Coinsurance after deductible 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
40.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$40.00 100.00% Exclusions include certain mental health and substance abuse services, including: aptitude tests, testing and treatment for learning disabilities, treatment for personality disorders, treatment [of] factitious disorders, treatment of sleep disorders, treatment of sexual and gender identity disorders, care beyond that needed to determine mental deficiency or retardation, marital/relationship counseling, and care at behavioral health facilities. Psychological tests (limit of 8 hours of tests per year).
Mental/Behavioral Health Inpatient Services
Covered
40.00% Coinsurance after deductible 100.00% Exclusions include certain mental health and substance abuse services, including: aptitude tests, testing and treatment for learning disabilities, treatment for personality disorders, treatment [of] factitious disorders, treatment of sleep disorders, treatment of sexual and gender identity disorders, care beyond that needed to determine mental deficiency or retardation, marital/relationship counseling, and care at behavioral health facilities. Methadone is not Covered
Substance Abuse Disorder Outpatient Services
Covered
$40.00 100.00%
Substance Abuse Disorder Inpatient Services
Covered
40.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
$20.00 100.00%
Preferred Brand Drugs
Covered
$40.00 100.00%
Non-Preferred Brand Drugs
Covered
$80.00 Copay after deductible 100.00%
Specialty Drugs
Covered
$125.00 Copay after deductible 100.00%
Outpatient Rehabilitation Services
Covered
40.00% Coinsurance after deductible 100.00%30 Visit(s) per Benefit Period OT and PT covered only when needed to help your condition improve in a reasonable and predictable time. Combined limit of 30 visits per benefit period for Rehabilitative Physical Therapy and Occupational Therapy; 30 visits per benefit period for Rehabilitative Speech Therapy.
Habilitation Services
Covered
40.00% Coinsurance after deductible 100.00%30 Visit(s) per Benefit Period Speech therapy is not covered for attention disorders, behavior problems, conceptual handicaps, learning disabilities, developmental delays. Combined limit of 30 visits per benefit period for Habilitative Physical Therapy and Occupational Therapy; 30 visits per benefit period for Habilitative Speech Therapy. Applied Behavior analysis for autism spectrum disorder is also covered,.
Chiropractic Care
Covered
40.00% Coinsurance after deductible 100.00% The following limits apply: three modalities per visit, one visit per day.
Durable Medical Equipment
Covered
40.00% Coinsurance after deductible 100.00%
Hearing Aids
Covered
40.00% Coinsurance after deductible 100.00%1 Item(s) per 3 Years Benefits are limited to one wearable hearing aid per ear every three (3) years
Imaging (CT/PET Scans, MRIs)
Covered
40.00% Coinsurance after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00% Colorectal cancer screening must be covered.
Routine Foot Care
Covered
40.00% Coinsurance after deductible 100.00%
Acupuncture
Weight Loss Programs
Routine Eye Exam for Children
Covered
40.00% Coinsurance after deductible 100.00%1 Exam(s) per Benefit Period
Eye Glasses for Children
Covered
40.00% Coinsurance after deductible 100.00%1 Item(s) per Benefit Period
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$40.00 100.00%30 Visit(s) per Benefit Period Speech therapy is not covered for attention disorders, behavior problems, conceptual handicaps, learning disabilities, developmental delays. Combined Rehabilitative and Habilitative limit of 30 visits per benefit period. Must be needed to improve speech problems caused by disease, trauma, congenital defect, or recent surgery.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$40.00 100.00%30 Visit(s) per Benefit Period OT and PT covered only when needed to help your condition improve in a reasonable and predictable time. Combined limit of 30 visits per benefit period for Rehabilitative Physical Therapy and Occupational Therapy. Must be needed to help your condition improve in a reasonable and predictable time, or needed to establish an effective home exercise program.
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
40.00% Coinsurance after deductible 100.00%
X-rays and Diagnostic Imaging
Covered
40.00% Coinsurance after deductible 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Orthodontia – Adult
Major Dental Care – Adult
Abortion for Which Public Funding is Prohibited
Not Covered
Elective abortions Plan covers non-elective abortions necessary to avert the death of the member or to terminate pregnancies caused by rape or incest
Transplant
Covered
40.00% Coinsurance after deductible 100.00% Your health benefit plan has a maximum benefit limit per transplant of $10,000 for each cadaveric organ and up to $45,000 for each organ procured from a living donor including organ harvesting. Kidney and bone marrow transplants do not apply to this limit. For kidney transplants, if there is not a network transplant facility available living donor costs are limited to $50,000 not including harvesting.
Accidental Dental
Covered
40.00% Coinsurance after deductible 100.00%
Dialysis
Covered
40.00% Coinsurance after deductible 100.00%
Allergy Testing
Covered
40.00% Coinsurance after deductible 100.00%
Chemotherapy
Covered
40.00% Coinsurance after deductible 100.00%
Radiation
Covered
40.00% Coinsurance after deductible 100.00% Radiation therapy is covered for cancer and neoplastic diseases.
Diabetes Education
Prosthetic Devices
Covered
40.00% Coinsurance after deductible 100.00%
Infusion Therapy
Covered
40.00% Coinsurance after deductible 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
40.00% Coinsurance after deductible 100.00% Treatment is covered if there is documented organic joint disease, or joint damage resulting from physical trauma
Nutritional Counseling
Covered
No Charge 100.00% Also covered per USPSTF guidelines.
Reconstructive Surgery
Covered
40.00% Coinsurance after deductible 100.00% Only for breast reconstruction.
Gender Affirming Care
Not Covered
Newborn Hearing Screening
Covered
No Charge 100.00%
Cancer Monitoring Test
Covered
40.00% Coinsurance after deductible 100.00%
Clinical Trials
Covered
40.00% Coinsurance after deductible 100.00%
Diabetes Care Management
Covered
40.00% Coinsurance after deductible 100.00%
Inherited Metabolic Disorder – PKU
Covered
40.00% Coinsurance after deductible 100.00%
Reversible Contraceptives
Covered
40.00% Coinsurance after deductible 100.00%
Autism Spectrum Disorders
Covered
40.00% Coinsurance after deductible 100.00%
School Based Health Centers
Covered
40.00% Coinsurance after deductible 100.00%
Dental Services for Children with Severe Disabilities
Covered
40.00% Coinsurance after deductible 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for AmeriHealth Caritas Next Silver + Free Telemedicine + Free Preventive Care + Healthy Rewards?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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