2019 Standard High Bronze: Tufts Health Direct Bronze 2750 Plan Details - HealthPocket

Standard High Bronze: Tufts Health Direct Bronze 2750

$243.45/mo

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Zip Code02128
Applicant4/21/1984 Male
Coverage Start4/22/2019
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameStandard High Bronze: Tufts Health Direct Bronze 2750
Plan IDhhs-59763MA0040014
Plan Year2019
Insurance ProviderTufts Health Plan
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$2,750
Out-of-Pocket Maximum$7,900
Personal Score

Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay after deductible
Specialist Visit$50 Copay after deductible
Laboratory Outpatient and Professional Services$50 Copay after deductible
X-rays and Diagnostic Imaging$50 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$500 Copay after deductible
Deductible - Family$5500 per group
Out-of-Pocket Maximum - Family$15800 per group

Prescription drug coverage

Generic Drugs$25 Copay
Preferred Brand Drugs$50 Copay after deductible
Non-Preferred Brand Drugs$100 Copay after deductible
Specialty Drugs$100 Copay after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.tuftshealthplan.com
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 - Emergency care only
Does this plan cover services outside the country?Yes - Emergency care only

Hospital services

Emergency Room Services$250 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$750 Copay per Stay after deductible
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance ServiceNot Applicable

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care$750 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$25 Copay after deductible
Mental/Behavioral Health Inpatient Services$750 Copay per Stay after deductible
Substance use disorder outpatient services$25 Copay after deductible
Substance use disorder inpatient services$750 Copay per Stay after deductible

Medical Management Programs

Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

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)
Acupuncture
Bariatric Surgery
Infertility Treatment
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
Habilitation Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Weight Loss Programs
Outpatient Rehabilitation Services
Dental Check-Up for Children
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsCosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
PremiumPlan NameDeductible
from $453
HMO Blue Basic Deductible
$2,750.00Select
from $476
Standard High Bronze
$2,750.00Select
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Fantes, Jackie
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Chou, Loretta
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Silva, Catherine
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Williams, Charles
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Kostich, Mirjana
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Haddad, Heba
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Shopland, Victoria
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Maclean, Jessica
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Nunez, Nairoby
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Bird, Julia
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Carr, Alison
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Trussell, Kelly
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D'aurora, Adrianna
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East Boston Physical Therapy Center, Inc.
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Gonzalez, Marissa
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Young, Maureen
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Del Rey, Caroline
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Llovet, Aliza
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Slowe, Erin
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Borda Sanchez, Gustavo
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Jackie Fantes, MD
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  • Phone Number
    (617) 569-5800
  • Office Locations
    10 Gove St
    East Boston, MA 02128
10 Gove St East Boston MA, 02128

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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)