HMO Blue Essential Plan Details for 2021- HealthPocket

HMO Blue Essential

$304.28/mo

Apply For This Plan

Zip Code02128
Applicant11/24/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHMO Blue Essential
Plan IDhhs-42690MA1290014
Plan Year2020
Insurance ProviderBlue Cross Blue Shield of Massachusetts
Metal LevelCatastrophic
Plan TypeHMO
Deductible$7,800
Out-of-Pocket Maximum$7,800
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay
Specialist VisitNot Applicable
Laboratory Outpatient and Professional ServicesNot Applicable
X-rays and Diagnostic ImagingNot Applicable
Diagnostic Imaging such as MRIs, CT, and PET scansNot Applicable
Deductible - Family$15600 per group
Out-of-Pocket Maximum - Family$15600 per group

Prescription drug coverage

Generic DrugsNot Applicable
Preferred Brand DrugsNot Applicable
Non-Preferred Brand DrugsNot Applicable
Specialty DrugsNot Applicable

Access to doctors and hospitals

Provider directory URLhttp://www.bluecrossma.com/wps/portal/members/using-my-plan/doctors-hospitals/findadoctor/
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All professional provider specialists except for OB/GYN, Chiropractor, and Acupuncturist
Does this plan cover services outside plan service area?Yes - Emergency and Urgent Care Services only
Does this plan cover services outside the country?Yes - Emergency and Urgent Care Services only

Hospital services

Emergency Room ServicesNot Applicable
Inpatient Hospital Services (e.g., Hospital Stay)Not Applicable
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance ServiceNot Applicable

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity careNot Applicable

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
Mental/Behavioral Health Inpatient ServicesNot Applicable
Substance use disorder outpatient servicesNot Applicable
Substance use disorder inpatient servicesNot Applicable

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

Child Dental Coverage

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

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 BenefitsInfertility Treatment
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Bariatric Surgery
Other Practitioner Office Visit (Nurse, Physician Assistant)
Diabetes Care Management
Abortion for Which Public Funding is Prohibited
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Bone Marrow Transplants for Treatment of Breast Cancer
Cardiac Rehabilitation
Clinical Trials
Congenital Anomaly, including Cleft Lip/Palate
Contraceptive Services
Early Intervention Services
Hormone Replacement Therapy (HRT)
Human Leukocyte Antigen Testing
Hypodermic Syringes or Needles
Nutrition/Formulas
Off Label Prescription Drugs
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsWeight Loss Programs
Outpatient Rehabilitation Services
Habilitation Services
Hearing Aids
Acupuncture
Skilled Nursing Facility
Preventive Care/Screening/Immunization
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsLong-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Routine Foot Care
Cosmetic Surgery
Accidental Dental
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  • Phone Number
    (617) 569-5800
  • Office Locations
    10 Gove St
    East Boston, MA 02128
10 Gove St East Boston MA, 02128
  • What is the Catastrophic Plan?

    Catastrophic health insurance is a type of medical coverage under the Affordable Care Act. This is a type of high-deductible health plan for people under 30 or those who qualify for a "hardship exemption."

  • How are Catastrophic 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. There is no actuarial value associated with catastrophic plans but other Obamacare metal plans pay a higher percentage of these costs.

  • How much does a Catastrophic Plan cost?

    The monthly premium for a Catastrophic 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 Catastrophic Plan premiums in your area.

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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.