Blue Cross Select HMO Bronze Saver HSA Plan Details for 2020- HealthPocket

Blue Cross Select HMO Bronze Saver HSA

$234.28/mo

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Zip Code48228
Applicant7/10/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Cross Select HMO Bronze Saver HSA
Plan IDqhp-98185MI0440006
Plan Year2020
Insurance ProviderBlue Cross Blue Shield of Michigan
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$6,850
Out-of-Pocket Maximum$6,850
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$13700
Out-of-Pocket Maximum - Family$13700

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 URLhttps://www.bcbsm.com/index/common/marketplace/select-hmo.html

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 CareNot Applicable

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
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 BenefitsRehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Infertility Treatment
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Bariatric Surgery
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Weight Loss Programs
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
Non Preferred Generic Drugs
Non Preferred Specialty Drugs
More Excluded BenefitsDental Check-Up for Children
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Cosmetic Surgery
Hearing Aids
Routine Foot Care
Acupuncture
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $188
MyPriority HMO HSA Bronze 6900 - St. John Providence Network
$6,900.00Select
from $190
Blue Cross Metro Detroit HMO Bronze Saver HSA
$6,850.00Select
from $196
MyPriority HMO HSA Bronze 6900 - Beaumont Health Network
$6,900.00Select
from $211
Core Care Bronze 1
$6,800.00Select
from $215
Core Care Bronze 1 + Vision
$6,800.00Select
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  • Phone Number
    (313) 584-3624
  • Office Locations
    16551 W Warren Ave
    Detroit, MI 48228
16551 W Warren Ave Detroit MI, 48228

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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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).