Exchange


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DO YOU QUALIFY?

34 states have opted for the health insurance exchange provided by the federal government.

California opted to create its own exchange called Covered California.  Covered California
offers 4 plan tiers similar to the Federal Plan; Bronze, Silver, Gold & Platinum.
The plan summaries can be found at the bottom of this page.

  FPL 138% of FPL 400% of FPL
Family Size Gross Income Gross Income Gross Income
1 <$11,490 <$15,856 <$45,960
2 <$15,510 <$21,404 <$62,040
3 <$19,530 <$26,951 <$78,120
4 <$23,550 <$32,499 <$94,200
5 <$27,570 <$38,047 <$110,280
6 <$31,590 <$43,594 <$126,360

Many Californians will qualify for a premium credit if they earn less than 400% of the Federal Poverty Level or MediCal at less than 138% of poverty level.

Your premiums are the same regardless of whether or not you work with an agent.  Please enter “Ara Malazian” as your appointed agent on your Covered California Applications.
PLAN Bronze 60 Silver 70 Gold 80 Platinum 90
(Benefits in Blue are Subject to Deductibles) (Copays in Black are Not Subject to any Deductible and Count Toward the Annual Out-of-Pocket Maximum) www.hyehealth.com
Deductible $5000 deductible for medical & drugs $2000 medical deductible $250 brand drug  deductible no deductible no deductible
Preventative Care Copay (Deductible does not apply) no cost at least 1 yearly visit no cost at least 1 yearly visit no cost at least 1 yearly visit no cost at least 1 yearly visit
Primary Care Visit Copay $60 3 visits per year $45 $30 $20
Specialty Care Visit Copay $70 $65 $50 $40
Urgent Care Visit Copay $120 $90 $60 $40
Generic Medication $19 $19 $19 $5
Lab Testing Copay 30% $45 $30 $20
X-Ray Copay 30% $65 $50 $40
Emergency Room Copay $300 $250 $250 $150
High cost and infrequent services (e.g. Hospital Care) 30%of your plan’s negotiated rate 20% of your plan’s negotiated rate HMO Outpatient Surgery – $600 Hospital – $600/day up to 5 days PPO – 20% HMO Outpatient Surgery – $250 Hospital – $250/day up to 5 days PPO – 10%
Preferred brand copay after Drug Deductible (if any) $50 $50 $50 $15
Maximum Out-of-Pocket For One $6,350 $6,350 $6,350 $4,000
Maximum Out-of-Pocket For Family $12,700 $12,700 $12,700 $8,000
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