Zip Code | 28269 |
Applicant | 1/16/1986 Male |
Insurance Type | ACA (Obamacare) |
Plan Name | Blue Local Bronze 7500 (local network with Atrium Health) |
Plan ID | qhp-11512NC0140007 |
Plan Year | 2020 |
Insurance Provider | Blue Cross Blue Shield of North Carolina |
Metal Level | Expanded Bronze |
Plan Type | POS |
Deductible | $7,500 |
Out-of-Pocket Maximum | $8,150 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $45 Copay |
Specialist Visit | $115 Copay |
Laboratory Outpatient and Professional Services | 40.00% Coinsurance after deductible |
X-rays and Diagnostic Imaging | 40.00% Coinsurance after deductible |
Deductible - Family | $15000 |
Out-of-Pocket Maximum - Family | $16300 |
Prescription drug coverage | |
---|---|
Generic Drugs | $10 Copay |
Preferred Brand Drugs | $40 Copay |
Non-Preferred Brand Drugs | $80 Copay |
Specialty Drugs | 25% Coinsurance after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | https://healthnav.bcbsnc.com/?ci=COMMERCIAL&network_id=9 |
Hospital services | |
---|---|
Emergency Room Services | $650 Copay |
Inpatient Hospital Services (e.g., Hospital Stay) | 40% Coinsurance after deductible |
Inpatient Physician and Surgical Services | 40% Coinsurance after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | 40.00% Coinsurance after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | Not Applicable |
Mental/Behavioral Health Inpatient Services | 40.00% Coinsurance after deductible |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | Not Applicable |
Eye Glasses for Children | 50.00% |
Exclusions and Limitations | |
---|---|
More Included Benefits | Other Practitioner Office Visit (Nurse, Physician Assistant) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Hospice Services Infertility Treatment Private-Duty Nursing 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 Hearing Aids Imaging (CT/PET Scans, MRIs) Preventive Care/Screening/Immunization Routine Foot Care Dental Check-Up for Children Rehabilitative Speech Therapy Rehabilitative Occupational and Rehabilitative Physical Therapy Well Baby Visits and Care Transplant Accidental Dental Dialysis Allergy Testing Chemotherapy Radiation Diabetes Education Infusion Therapy Treatment for Temporomandibular Joint Disorders Nutritional Counseling Reconstructive Surgery Non-Emergency Care When Traveling Outside of the U.S. Dental Anesthesia Diabetes Care Management Clinical Trials Congenital Anomaly, including Cleft Lip/Palate Tier 2 Rx Tier 6 Rx Prenatal and Postnatal Care - Non-Global Maternity |
More Excluded Benefits | Long-Term/Custodial Nursing Home Care Cosmetic Surgery Acupuncture Weight Loss Programs Abortion for Which Public Funding is Prohibited Prosthetic Devices Off-label Prescription Drugs |
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.
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.