BSW Elite Gold HMO 001 ($0 Preventive Care and Preventive Rx Drugs) HMO

Scott and White Health Plan
Gold
The BSW Elite Gold HMO 001 ($0 Preventive Care and Preventive Rx Drugs) is a health plan issued by Scott and White Health Plan for the year 2021. The plan is offered by the U.S. federal government through Healthcare.gov under the Affordable Care Act.

Overview

Plan issuer
Scott and White Health Plan
Child-only offering
Allows Adult and Child-Only
Adult dental coverage
No
Child dental coverage
No
Plan type
HMO

The BSW Elite Gold HMO 001 ($0 Preventive Care and Preventive Rx Drugs) plan is a Health Maintenance Organization (HMO) plan. Your care is limited to doctors who work for for the HMO. Out-of-network care is usually not covered, except in emergencies.

Metal level
Gold

The metal type provides an estimate of how you and your insurance split the costs of healthcare. Gold plans have:

  • High monthly premium
  • Low costs when you need care
  • Deductibles are low

Gold plans are a good choice if you want to pay more each month to have more of your medical care costs covered. If you use a lot of care, a Gold plan could be a good value.

Contact

Customer service number
1-254-298-3000x20300
Toll-free customer service number
1-800-321-7947

Coverage

Doctor coverage

Primary care physician visit cost
$20
Specialist visit cost
$60
Emergency visit cost
$750 Copay after deductible
Inpatient facility cost
20% Coinsurance after deductible
Inpatient physician cost
20% Coinsurance after deductible

Drug coverage

Generic drug cost
$15
Preferred brand drug cost
$55
Non-preferred brand drug cost
$150
Specialty drug cost
$500

Deductible

Individual
Medical deductible individual
$2,000
Drug deductible individual
Included in Medical
Medical maximum out of pocket individual
$8,550
Drug maximum out of pocket individual
Included in Medical
Family
Medical deductible family
$4,000
Drug deductible family
Included in Medical
Medical maximum out of pocket family
$17,100
Drug maximum out of pocket family
Included in Medical
Family per person
Medical deductible family per person
$2,000
Drug deductible family per person
Included in Medical
Medical maximum out of pocket family per person
$8,550
Drug maximum out of pocket family per person
Included in Medical

Premium payment

The premium is the amount you pay for health insurance each month. This does not include other healthcare costs such as your deductible, copayments, and coinsurance.

Your premium depends on who is covered by the insurance and their ages. Generally, premiums increase if there are more people covered or if people covered are older.

Premium rates

Coverage Monthly premium Annual premium
Child (age 0-14) $286.07 $3,432.84
Child (age 18) $341.41 $4,096.92
Adult individual (age 21) $373.94 $4,487.28
Adult individual (age 27) $391.89 $4,702.68
Adult individual (age 30) $424.43 $5,093.16
Adult individual (age 40) $477.90 $5,734.80
Adult individual (age 50) $667.86 $8,014.32
Adult individual (age 60) $1,014.89 $12,178.68
Couple (age 21) $747.88 $8,974.56
Couple (age 30) $848.86 $10,186.32
Couple (age 40) $955.80 $11,469.60
Couple (age 50) $1,335.72 $16,028.64
Couple (age 60) $2,029.78 $24,357.36
Couple (age 21) plus 1 child $1,033.95 $12,407.40
Couple (age 30) plus 1 child $1,134.93 $13,619.16
Couple (age 40) plus 1 child $1,241.87 $14,902.44
Couple (age 50) plus 1 child $1,621.79 $19,461.48
Couple (age 21) plus 2 children $1,320.02 $15,840.24
Couple (age 30) plus 2 children $1,421.00 $17,052.00
Couple (age 40) plus 2 children $1,527.94 $18,335.28
Couple (age 50) plus 2 children $1,907.86 $22,894.32
Couple (age 21) plus 3 or more children $1,606.09 $19,273.08
Couple (age 30) plus 3 or more children $1,707.07 $20,484.84
Couple (age 40) plus 3 or more children $1,814.01 $21,768.12
Couple (age 50) plus 3 or more children $2,193.93 $26,327.16
Single parent (age 21) plus 1 child $660.01 $7,920.12
Single parent (age 30) plus 1 child $710.50 $8,526.00
Single parent (age 40) plus 1 child $763.97 $9,167.64
Single parent (age 50) plus 1 child $953.93 $11,447.16
Single parent (age 21) plus 2 children $946.08 $11,352.96
Single parent (age 30) plus 2 children $996.57 $11,958.84
Single parent (age 40) plus 2 children $1,050.04 $12,600.48
Single parent (age 50) plus 2 children $1,240.00 $14,880.00
Single parent (age 21) plus 3 or more children $1,232.15 $14,785.80
Single parent (age 30) plus 3 or more children $1,282.64 $15,391.68
Single parent (age 40) plus 3 or more children $1,336.11 $16,033.32
Single parent (age 50) plus 3 or more children $1,526.07 $18,312.84

Source

Our data is directly sourced from Healthcare.gov, the U.S. federal government's Health Insurance Marketplace®, created under the Affordable Care Act.