Ambetter Essential Care 2 HSA (2020) Plan Details for 2021- HealthPocket

Ambetter Essential Care 2 HSA (2020)

$300.48/mo

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Zip Code46227
Applicant12/2/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAmbetter Essential Care 2 HSA (2020)
Plan IDqhp-76179IN0110052
Plan Year2020
Insurance ProviderAmbetter
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$6,750
Out-of-Pocket Maximum$6,750
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or IllnessNo Charge after Deductible
Specialist VisitNo Charge after Deductible
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNo Charge after deductible
Deductible - Family$13500
Out-of-Pocket Maximum - Family$13500

Prescription drug coverage

Generic DrugsNo Charge after Deductible
Preferred Brand DrugsNo Charge after Deductible
Non-Preferred Brand DrugsNo Charge after Deductible
Specialty DrugsNo Charge after Deductible

Access to doctors and hospitals

Provider directory URLhttp://ambetter.mhsindiana.com/findadoc

Hospital services

Emergency Room ServicesNo Charge after Deductible
Inpatient Hospital Services (e.g., Hospital Stay)No Charge after Deductible
Inpatient Physician and Surgical ServicesNo Charge after Deductible

Maternity

Prenatal and Postnatal CareNo Charge after deductible

Mental Health

Mental/Behavioral Health Outpatient ServicesNo Charge after deductible
Mental/Behavioral Health Inpatient ServicesNo Charge after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Private-Duty Nursing
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Routine Foot Care
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $421
Ambetter Essential Care 2 HSA (2021)
$6,900.00Select
from $439
Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental
$6,900.00Select
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Jane, Wilson
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Carol, Johnson
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Kevin, Julian
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Karamchand, Paul
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Bipinchandra, Patel
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Wynter, Vik
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Candelaria, Cordova
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Amanda, Smith
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Susan, Tanney
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Mary, Driskell
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Anna, Lynch
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Alyssa, Emata
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Dylan, Wirick
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Mariesa, Mclean
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Elise, Birch
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Zachry, Skinner
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Katrina, Morgan
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Lauren, Ferendo
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Miranda, Mazza
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Marisa, Kitt
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Emma, Engdahl
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Jane Wilson, MD
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  • Phone Number
    (317) 780-4080
  • Office Locations
    5550 S East St
    Indianapolis, IN 46227
5550 S East St Indianapolis IN, 46227

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HealthPocket.com provides information on insurance products. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Always review the privacy and terms of use of the partner website.

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 Benefytt Technologies, Inc. family of companies.