TrueHealth HMO 6000 - PimaFocus Network Plan Details for 2021- HealthPocket

TrueHealth HMO 6000 - PimaFocus Network

$337.25/mo

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Zip Code85364
Applicant12/3/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameTrueHealth HMO 6000 - PimaFocus Network
Plan IDhhs-53901AZ1420047
Plan Year2020
Insurance ProviderBlue Cross Blue Shield of Arizona
Metal LevelSilver
Plan TypeHMO
Deductible$6,000
Out-of-Pocket Maximum$6,500
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$25 Copay
Specialist Visit$100 Copay
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNo Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scansNo Charge after deductible
Deductible - Family$12000 per group
Out-of-Pocket Maximum - Family$13000 per group

Prescription drug coverage

Generic Drugs$25 Copay
Preferred Brand Drugs$100 Copay
Non-Preferred Brand DrugsNo Charge after deductible
Specialty Drugs50.00% Coinsurance

Access to doctors and hospitals

Provider directory URLhttps://www.azblue.com/individualsandfamilies/find-a-doctor
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Telehealth and Urgent Care services and Emergency services.
Does this plan cover services outside plan service area?Yes - Emergencies and Authorized Follow-up Care
Does this plan cover services outside the country?Yes - Emergencies Only

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
Emergency Transportation or Ambulance ServiceNo Charge after deductible

Maternity

Prenatal and Postnatal Care$100 Copay
Delivery and all inpatient services for maternity careNo Charge after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$100 Copay
Mental/Behavioral Health Inpatient ServicesNo Charge after deductible
Substance use disorder outpatient services$100 Copay
Substance use disorder inpatient servicesNo Charge after deductible

Medical Management Programs

Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Bariatric Surgery
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Hospice Services
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $307
Ambetter Balanced Care 201 HSA (2021)
$5,800.00Select
from $322
Ambetter Balanced Care 201 HSA (2021) + Vision + Adult Dental
$5,800.00Select
from $480
Ambetter Balanced Care 11 (2021)
$6,000.00Select
from $503
Ambetter Balanced Care 11 (2021) + Vision + Adult Dental
$6,000.00Select
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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
  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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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 Benefytt Technologies, Inc. family of companies.