AultCare Bronze Standard Select No Pediatric Dental Plan Details for 2020- HealthPocket

AultCare Bronze Standard Select No Pediatric Dental

$302.22/mo

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Zip Code43228
Applicant1/22/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAultCare Bronze Standard Select No Pediatric Dental
Plan IDqhp-28162OH0060080
Plan Year2020
Insurance ProviderAultCare
Metal LevelExpanded Bronze
Plan TypePPO
Deductible$6,650
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay
Specialist Visit$75 Copay
Laboratory Outpatient and Professional Services40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible
Deductible - Family$13300
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs40% Coinsurance after deductible
Preferred Brand Drugs40% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs40% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://directory.aultcare.com/directory/SELECT%20PPO

Hospital services

Emergency Room Services40% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40% Coinsurance after deductible
Inpatient Physician and Surgical Services40% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for Children0.00%
Eye Glasses for Children40.00% Coinsurance after deductible

Exclusions and Limitations

More Included BenefitsInpatient Physician and Surgical Services
Skilled Nursing Facility
Other 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
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
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 BenefitsBariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Hearing Aids
Routine Foot Care
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $212
Ambetter Essential Care 2 HSA (2020)
$6,750.00Select
from $250
Ambetter Balanced Care 12 (2020)
$6,500.00Select
from $284
Core Care Bronze 1
$6,800.00Select
from $286
Ambetter Essential Care 2 HSA (2020)
$6,750.00Select
from $288
Core Care Bronze 1 +Vision
$6,800.00Select
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  • Phone Number
    (614) 486-2000
  • Office Locations
    5131 Beacon Hill Rd
    Columbus, OH 43228
5131 Beacon Hill Rd Columbus OH, 43228

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).