2019 PQA Southeast Bronze Connect 7900 Plan Details - HealthPocket

PQA Southeast Bronze Connect 7900

$346.71/mo

Apply For This Plan

Zip Code83709
Applicant7/22/1984 Male
Coverage Start7/23/2019
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NamePQA Southeast Bronze Connect 7900
Plan IDhhs-61589ID2360104
Plan Year2019
Insurance ProviderBlue Cross of Idaho
Metal LevelExpanded Bronze
Plan TypePOS
Deductible$7,900
Out-of-Pocket Maximum$7,900
Personal Score

Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$55 Copay
Specialist Visit$110 Copay
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNo Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scansNo Charge after deductible
Deductible - Family$15800 per group
Out-of-Pocket Maximum - Family$15800 per group

Prescription drug coverage

Generic Drugs$10 Copay
Preferred Brand Drugs$30 Copay after deductible
Non-Preferred Brand Drugs$50 Copay after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.bcidaho.com/BCI_V2/prov_directory/prov_dir_criteria.aspx
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Yes - Allergy/Immunology, Audiologist,Cardiology, Cardiothoracic Surgery, Colorectal Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Gastroenterology, General Surgery, Hand Surgery, Hepatologist, Infectious Disease, Nephrology, Neurology, Neurosurgery, Oncology/Hematology, Oral Surgery, Ophthalmology, Orthopedics, Pain Management, Perinatologist, Plastic Surgery, Podiatry, Proctology, Psychiatry, Pulmonology, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery
Does this plan cover services outside plan service area?Yes - In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services.
Does this plan cover services outside the country?Yes - The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply.

Hospital services

Emergency Room Services$350 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)No Charge after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Emergency Transportation or Ambulance ServiceNo Charge after deductible

Maternity

Prenatal and Postnatal CareNo Charge after deductible
Delivery and all inpatient services for maternity careNo Charge after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$55 Copay
Mental/Behavioral Health Inpatient ServicesNo Charge after deductible
Substance use disorder outpatient services$55 Copay
Substance use disorder inpatient servicesNo Charge after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Well Baby Visits and Care
More Limited BenefitsSkilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Nutritional Counseling
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Treatment for Temporomandibular Joint Disorders
PremiumPlan NameDeductible
from $258
CPN North Central Catastrophic 7900
$7,900.00Select
from $259
BrightIdea Catastrophic
$7,900.00Select
from $261
SelectHealth Catastrophic 7900
$7,900.00Select
from $270
IDID Southwest Catastrophic 7900
$7,900.00Select
from $273
KCN North Catastrophic 7900
$7,900.00Select
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  • Phone Number
    (208) 302-5600
  • Office Locations
    10255 W. Overland Rd
    Boise, ID 83709
10255 W. Overland Rd Boise ID, 83709

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)