2019 Anthem HealthKeepers Bronze 4900 for HSA Plan Details - HealthPocket

Anthem HealthKeepers Bronze 4900 for HSA

$421.99/mo

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Zip Code23464
Applicant10/16/1984 Male
Coverage Start10/17/2019
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAnthem HealthKeepers Bronze 4900 for HSA
Plan IDhhs-88380VA0720020
Plan Year2019
Insurance ProviderAnthem BCBS
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$4,900
Out-of-Pocket Maximum$6,700
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness35.00% Coinsurance after deductible
Specialist Visit35.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services35.00% Coinsurance after deductible
X-rays and Diagnostic Imaging35.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans50.00% Coinsurance after deductible
Deductible - Family$9800 per group
Out-of-Pocket Maximum - Family$13400 per group

Prescription drug coverage

Generic Drugs35.00% Coinsurance after deductible
Preferred Brand Drugs35.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.anthem.com/health-insurance/provider-directory/searchcriteria?branding=ABCBS&state=VA
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - TRAD/PAR network
Does this plan cover services outside the country?Yes - Urgent/Emergency Coverage Only

Hospital services

Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)35.00% Coinsurance after deductible
Inpatient Physician and Surgical Services35.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service35.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care35.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care35.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services35.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services35.00% Coinsurance after deductible
Substance use disorder outpatient services35.00% Coinsurance after deductible
Substance use disorder inpatient services35.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management
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 CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

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
Habilitation Services
Durable Medical Equipment
Hospice Services
Dental Anesthesia
Diabetes Care Management
Mental Health Other
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Blood and Blood Services
Bones/Joints
Clinical Trials
Early Intervention Services
Rape and Incest Coverage
More Limited BenefitsSkilled Nursing Facility
Private-Duty Nursing
Home Health Care Services
Outpatient Rehabilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Non-Emergency Care When Traveling Outside the U.S.
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $1,340
IH Classic 5000: MO
$5,000.00Select
from $1,385
Aetna Classic 5000: MO
$5,000.00Select
from $1,656
Vantage Equity 4750_MO
$4,750.00Select
from $180
KP VA Bronze 5000/30%/HSA/Dental
$5,000.00Select
from $203
IH Classic 5000
$5,000.00Select
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Charles, Fayton
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Reynaldo, Francisco
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Francisco, Espada
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Maxine, Beatty
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Sally, James
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Michael, Livoti
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Tamara, Tugung
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Taylor, Braegelman
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Atlantic Surgical Assistants, Inc
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Brenna, Fencil
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Allison, Taliaferro
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Amber, Scanlon
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Talya, Singleton
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Robyn, Toran
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Brittany, Wulfsberg
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Michael, Mascolo
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Donna, Gorman
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Theresa, Smith
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Morgan, Benson
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Jenna, Duncan
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Sherri, Hughes
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Charles Fayton, M.D.
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  • Phone Number
    (757) 420-6218
  • Office Locations
    6477 College Park Sq
    Virginia Beach, VA 23464
6477 College Park Sq Virginia Beach VA, 23464

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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 part of the Health Insurance Innovations, Inc. family of companies (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, or an individual and family 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 part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).