Confident Care Gold 8

18167UT0010008
Gold
HMO

Confident Care Gold 8 is a Gold HMO plan by Molina Healthcare.

IMPORTANT: You are viewing the 2023 version of Confident Care Gold 8 18167UT0010008. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Confident Care Gold 8 is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Confident Care Gold 8 18167UT0010008.
Insurer: Molina Healthcare
Network Type: HMO
Metal Type: Gold
HSA Eligible?: No
Plan ID: 18167UT0010008

Cost-Sharing Overview

Confident Care Gold 8 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 Confident Care Gold 8?

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

Confident Care Gold 8 offers the following features and referral requirements.

Wellness Program: Yes
Disease Program:
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 Confident Care Gold 8 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: Molina covers emergencies only.
National Network: No

Additional Benefits and Cost-Sharing

Confident Care Gold 8 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
$30.00 100.00%
Specialist Visit
Covered
$60.00 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$30.00 100.00% This benefit includes Mental Health and Substance Use Disorder providers in an office setting.
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
25.00% Coinsurance after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
25.00% Coinsurance after deductible 100.00%
Hospice Services
Covered
No Charge 100.00%6 Months per 3 Years Requires Pre-authorization and Medical Case Management.
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$45.00 100.00%
Home Health Care Services
Covered
No Charge 100.00%30 Visit(s) per Benefit Period
Emergency Room Services
Covered
25.00% Coinsurance after deductible 25.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
25.00% Coinsurance after deductible 25.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
25.00% Coinsurance after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
25.00% Coinsurance after deductible 100.00%
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
25.00% Coinsurance after deductible 100.00%30 Visit(s) per Benefit Period Requires Pre-authorization and Medical Case Management.
Prenatal and Postnatal Care
Covered
No Charge 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
25.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$30.00 100.00%
Mental/Behavioral Health Inpatient Services
Covered
25.00% Coinsurance after deductible 100.00% .
Substance Abuse Disorder Outpatient Services
Covered
$30.00 100.00%
Substance Abuse Disorder Inpatient Services
Covered
25.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
$15.00 100.00%30 Item(s) per Month
Preferred Brand Drugs
Covered
$30.00 100.00%30 Item(s) per Month Per Utah State Law, during calendar year 2022, the insulin prescription cap for a 30-day prescription supply of at least one insulin in each therapy category will $28.00
Non-Preferred Brand Drugs
Covered
$60.00 100.00%30 Item(s) per Month Per Utah State Law, during calendar year 2022, the insulin prescription cap for a 30-day prescription supply of at least one insulin in each therapy category will $28.00
Specialty Drugs
Covered
$250.00 100.00%30 Item(s) per Month
Outpatient Rehabilitation Services
Covered
$30.00 100.00%20 Visit(s) per Benefit Period Pre-authorization required only for home visits. Rehabilitation therapy will be defined as, The treatment of disease, injury, developmental delay or other cause, by physical agents and methods to assist in the rehabilitation of normal physical bodily function, that is goal oriented and where the Member has the potential for functional improvement and ability to progress. Habilitative and Rehabilitative Services benefits have a combined limit of 20 visits per calendar year. Member Cost Sharing and visit limits shown apply in any place of service.
Habilitation Services
Covered
$30.00 100.00%20 Visit(s) per Benefit Period Pre-authorization required only for home visits. Adopt the habilitation therapy definition as, Health care services that help a person keep, learn or improve skills and functioning for daily living which may include physical therapy, occupational therapy, and speech language pathology. Habilitative and Rehabilitative Services benefits have a combined limit of 20 visits per calendar year. Member Cost Sharing and visit limits shown apply in any place of service.
Chiropractic Care
Not Covered
Durable Medical Equipment
Covered
25.00% Coinsurance after deductible 100.00% DME over $750, rentals, that exceed 60 days, or as indicated in Appendix A of the Master Policy require Pre-authorization.
Hearing Aids
Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
25.00% Coinsurance after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00%
Routine Foot Care
Not Covered
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Visit(s) per Benefit Period
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Benefit Period Molina covers frames, lenses, and contact lenses (in lieu of glasses) are covered for children.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$30.00 100.00%20 Visit(s) per Benefit Period Pre-authorization required only for home visits.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$30.00 100.00%20 Visit(s) per Benefit Period Pre-authorization required only for home visits.
Well Baby Visits and Care
Covered
No Charge 100.00% Benefit should mirror preventive care/screening/immunization.
Laboratory Outpatient and Professional Services
Covered
25.00% Coinsurance after deductible 100.00%
X-rays and Diagnostic Imaging
Covered
25.00% 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
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
25.00% Coinsurance after deductible 100.00%
Accidental Dental
Not Covered
Dialysis
Covered
$60.00 100.00%
Allergy Testing
Covered
$30.00 100.00% Sublingual or colorimetric allergy testing are not covered. Charges for office visits in connection with repetitive injections are not covered.
Chemotherapy
Covered
25.00% Coinsurance after deductible 100.00%
Radiation
Covered
25.00% Coinsurance after deductible 100.00%
Diabetes Education
Covered
No Charge 100.00% Must be for the diagnosis of diabetes.
Prosthetic Devices
Covered
25.00% Coinsurance after deductible 100.00% Coverage limited to: ? Prostheses needed after a Medically Necessary mastectomy, including custom-made prostheses when Medically Necessary and up to three brassieres required to hold a prosthesis every 12 months ? Prostheses to replace all or part of an external facial body part (including artificial eyes), that has been removed or impaired as a result of disease, injury, or congenital defect
Infusion Therapy
Covered
25.00% Coinsurance after deductible 100.00%
Treatment for Temporomandibular Joint Disorders
Not Covered
Nutritional Counseling
Not Covered
Reconstructive Surgery
Covered
25.00% Coinsurance after deductible 100.00% Covers mastectomy in the treatment of cancer and reconstructive surgery after a mastectomy.
Gender Affirming Care
Covered
$30.00 100.00%
Autism Spectrum Disorders
Covered
$30.00 100.00%
Inherited Metabolic Disorder – PKU
Covered
$30.00 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following Confident Care Gold 8 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 Confident Care Gold 8 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 Confident Care Gold 8?

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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