Portfolio HSA HMO 5000 - PimaFocus Network Plan Details for 2020- HealthPocket

Portfolio HSA HMO 5000 - PimaFocus Network

$231.17/mo

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Zip Code85364
Applicant10/29/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NamePortfolio HSA HMO 5000 - PimaFocus Network
Plan IDqhp-53901AZ1420071
Plan Year2020
Insurance ProviderBlue Cross Blue Shield of Arizona
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,000
Out-of-Pocket Maximum$6,750
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness10% Coinsurance after deductible
Specialist Visit10% Coinsurance after deductible
Laboratory Outpatient and Professional Services10.00% Coinsurance after deductible
X-rays and Diagnostic Imaging10.00% Coinsurance after deductible
Deductible - Family$10000
Out-of-Pocket Maximum - Family$13500

Prescription drug coverage

Generic Drugs10% Coinsurance after deductible
Preferred Brand Drugs10% Coinsurance after deductible
Non-Preferred Brand Drugs10% Coinsurance after deductible
Specialty Drugs10% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.azblue.com/PimaFocus

Hospital services

Emergency Room Services10% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)10% Coinsurance after deductible
Inpatient Physician and Surgical Services10% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care10.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services10.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services10.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for Children10.00% Coinsurance after deductible
Eye Glasses for ChildrenNo Charge after deductible

Exclusions and Limitations

More Included BenefitsChiropractic Care
Durable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Dental Check-Up for Children
Rehabilitative 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
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
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 BenefitsRoutine Foot Care
Acupuncture
Weight Loss Programs
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Cosmetic Surgery
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $282
Portfolio HSA HMO 5000 - PimaFocus Network
$5,000.00Select
from $343
Oscar Classic Silver
$5,000.00Select
from $370
Classic Silver Off-Ex Only (Free 24/7 Telemedicine + Free Preve
$5,000.00Select
from $419
Classic Silver (Free 24/7 Telemedicine + Free Preventive Care)
$5,000.00Select
from $436
Portfolio HSA HMO 5000 - Neighborhood Network
$5,000.00Select
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  • Phone Number
    (602) 273-6770
  • Office Locations
    2400 S Avenue A
    Yuma, AZ 85364
2400 S Avenue A Yuma AZ, 85364

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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.