HA Silver Plan Standardized

13262AR0230005
Silver
POS

HA Silver Plan Standardized is a Silver POS plan by Health Advantage.

IMPORTANT: You are viewing the 2023 version of HA Silver Plan Standardized 13262AR0230005. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

HA Silver Plan Standardized is offered in the following counties.

No data was found

Plan Overview

This is a plan overview for 2023 version of HA Silver Plan Standardized 13262AR0230005.
Insurer: Health Advantage
Network Type: POS
Metal Type: Silver
HSA Eligible?: No
Plan ID: 13262AR0230005

Cost-Sharing Overview

HA Silver Plan Standardized 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 HA Silver Plan Standardized?

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

HA Silver Plan Standardized offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Notice Pregnancy: Yes
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions: No
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what HA Silver Plan Standardized covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Emergency Care
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Benefit Reduction
National Network: No

Additional Benefits and Cost-Sharing

HA Silver Plan Standardized 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 50.00% Coinsurance after deductible
Specialist Visit
Covered
$80.00 50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$40.00 50.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Outpatient Surgery Physician/Surgical Services
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Hospice Services
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage. If the Covered Person has been diagnosed and certified by the attending Physician as having a terminal illness with a life expectancy of six months or less, Health Advantage will pay the Allowance or Allowable Charge for Hospice Care. The services must be rendered by an entity licensed by the Arkansas Department of Health or other appropriate state licensing agency and accepted by Health Advantage as a Provider. This benefit is subject to the Deductible, Copayment and Coinsurance specified in the Schedule of Benefits.
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)
Covered
No Charge No Charge 100.00%1 Visit(s) per 2 Years
Urgent Care Centers or Facilities
Covered
$60.00 50.00% Coinsurance after deductible
Home Health Care Services
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible50 Visit(s) per Year Requires Prior Approval from Health Advantage. Coverage is provided for Home Health Services when Coverage Policy supports the need for in-home service and such care is prescribed or ordered by a Physician. Covered Services must be provided through and billed by a licensed home health agency. Covered Services provided in the home include services of a Registered Professional Nurse (R.N.), a Licensed Practical Nurse (L.P.N.) or a Licensed Psychiatric Technical Nurse (L.P.T.N.).
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
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Inpatient Physician and Surgical Services
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible60 Days per Year Requires Prior Approval from Health Advantage. 1. The admission must be within seven days of release from an inpatient Hospital stay; 2. The Skilled Nursing Facility services are of a temporary nature and increase ability to function.
Prenatal and Postnatal Care
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Notification to Health Advantage. Coverage for routine ultrasound is limited to 1.
Delivery and All Inpatient Services for Maternity Care
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Childbirth/delivery professional services: 13262AR0230005-01-40% Coinsurance after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 13262AR0230005-02-No charge for in-network and out-of-network services; 13262AR0230005-03-40% Coinsurance after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 13262AR0230005-04-40% Coinsurance after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 13262AR0230005-05-30% Coinsurance after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 13262AR0230005-06-25% Coinsurance for in-network services and 50% Coinsurance after deductible for out-of-network services; Coverage for Out of Network newborn services is limited to $2000 per person for all services first 90 days after birth. Coverage requires Prior Notification to Health Advantage.
Mental/Behavioral Health Outpatient Services
Covered
$40.00 50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Substance Abuse Disorder Outpatient Services
Covered
$40.00 50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
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
$350.00 Copay after deductible 100.00% Requires Prior Approval from Health Advantage.
Outpatient Rehabilitation Services
Covered
$40.00 100.00%30 Visit(s) per Year Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.
Habilitation Services
Covered
$40.00 100.00%30 Visit(s) per Year Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro; Limited to a maximum of 180 units for developmental services visits per Covered Person per calendar year.
Chiropractic Care
Covered
$40.00 100.00%30 Visit(s) per Year Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.
Durable Medical Equipment
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage for services $500 or more
Hearing Aids
Covered
No Charge No ChargeNo Charge No Charge Coverage is limited to $1400/ear
Imaging (CT/PET Scans, MRIs)
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage for high tech radiology services
Preventive Care/Screening/Immunization
Covered
No Charge 100.00%1 Visit(s) per Year
Routine Foot Care
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge No Charge 100.00%1 Exam(s) per Year
Eye Glasses for Children
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible1 Item(s) per Year
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$40.00 100.00%30 Visit(s) per Year Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$40.00 100.00%30 Visit(s) per Year Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.
Well Baby Visits and Care
Covered
No Charge No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible
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
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Accidental Dental
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Dialysis
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Allergy Testing
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible SOB includes ‘allergy services.’
Chemotherapy
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Radiation
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Diabetes Education
Covered
No Charge No Charge 100.00%
Prosthetic Devices
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage for any device for which cost exceeds $5,000. Replaced no more frequently than once per 3-yr period except when necessary for growth or end of device’s useful life.
Infusion Therapy
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Home infusion therapy.
Treatment for Temporomandibular Joint Disorders
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Nutritional Counseling
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Coverage is provided for dietary and nutritional counseling services when provided in conjunction with diabetic self-management training, for services needed by covered persons in connection with cleft palate management and for nutritional assessment programs provided in and by a hospital and approved by Health Advantage.
Reconstructive Surgery
Covered
40.00% Coinsurance after deductible 100.00% Requires Prior Approval from Health Advantage. 1. Treatment provided for the correction of defects incurred in an Accidental Injury sustained by the Covered Person; 2. Surgery performed for the removal of a port-wine stain or hemangioma (only on the face) 3. Treatment provided for reconstructive surgery following neoplastic (cancer) surgery; 4. In connection with a mastectomy resulting from surgery, services for (a) reconstruction of the breast on which the cancer-related surgery was performed; (b) surgery to reconstruct the other breast to produce a symmetrical appearance; and (c) prostheses and services to correct physical complications for all stages of the mastectomy, including lymphedemas; 5. Reduction mammoplasty, if such reduction mammoplasty meets Coverage Criteria and is Prior Approved by Health Advantage is covered.
Gender Affirming Care
Covered
40.00% Coinsurance after deductible 100.00% Requires Prior Approval from Health Advantage.
Diabetes Care Management
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible
Inherited Metabolic Disorder – PKU
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Off Label Prescription Drugs
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Dental Anesthesia
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Gastric Electrical Stimulation
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Well Child Care
Covered
No Charge No Charge 100.00%
Applied Behavior Analysis Based Therapies
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Cochlear Implants
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage. One cochlear implant per ear per Covered Person per lifetime
Craniofacial Surgery
Covered
40.00% Coinsurance after deductible 50.00% Coinsurance after deductible Requires Prior Approval from Health Advantage.
Specialty Drugs Tier 2
Covered
$350.00 Copay after deductible 100.00% Requires Prior Approval from Health Advantage.
Preventive Drugs
Covered
No Charge No Charge 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following HA Silver Plan Standardized 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 HA Silver Plan Standardized 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 HA Silver Plan Standardized?

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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