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Songer Benefits, Inc. Blog

All You Ever Wanted to Know About Insurance

Essential Health Insurance Beckley West Virginia

Essential Health Benefits in West Virginia are divided into ten categories of services. These categories must be included in the services offered by a health insurance plan or insurer for that plan to participate in the health insurance exchange marketplace in West Virginia. The categories of essential health benefits include • ambulatory patient services • emergency services • hospitalization • maternity and newborn care • mental health services • prescription drugs • rehabilitative and habilitative services • laboratory services • preventive, wellness, and chronic disease management service • pediatric services including vision and dental To place a cap on cost-sharing, maximum deductibles and out-of-pocket maximums were established. For 2016, the maximum deductible is $2,000 for an individual and $4,000 for a family. The out-of-pocket maximum in 2016 is $6,850 for an individual and $13,700 for families. The offering of four tiers of coverage provides the standardized benefit plan design: • bronze — pays 60% of full actuarial value for claims • silver — pays 70% of full actuarial value for claims • gold — pays 80% of full actuarial value for claims • platinum — pays 90% of full actuarial values for claims These plans are often referred to as the “metal” plans. The tables below show a example of the exchange benefit plan designs for the metals plans for two different state exchanges. Table Comparison of Bronze Tier Plans Benefit Sample State 1 State 1 State 2 Standard Bronze Plan Bronze HSA Plan (in network) Standard Bronze Plan Deductible (Individual) $5,000 Medical and Rx — combined $4,500 Medical and Rx — combined $3,000 individual Out-of-pocket limit $6,350 — individual $6,350 — individual $6,350 — individual Primary care office visit $60** 40%* 50% * Specialist visit $70 40%* 50% * Inpatient hospitalization 30%* 40%* 50%* Preventive care no cost share Lab in PCP office 30%* 40%* 50% * X-ray in PCP office 30%* 40%* 5. Call Songer Benefits in West Virginia for the best health insurance available.