CareSource Marketplace Bronze Dental, Vision, & Fitness Plan Details for 2020- HealthPocket

CareSource Marketplace Bronze Dental, Vision, & Fitness

$435.12/mo

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Zip Code25302
Applicant7/8/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameCareSource Marketplace Bronze Dental, Vision, & Fitness
Plan IDqhp-50328WV0020024
Plan Year2020
Insurance ProviderCareSource
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$7,700
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$60 Copay
Specialist Visit$120 Copay
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
X-rays and Diagnostic ImagingNot Applicable
Deductible - Family$15400
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs$40 Copay
Preferred Brand Drugs50% Coinsurance after deductible
Non-Preferred Brand Drugs50% Coinsurance after deductible
Specialty Drugs50% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.caresource.com/wv/members/tools-resources/find-a-doctor/marketplace

Hospital services

Emergency Room Services50% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50% Coinsurance after deductible
Inpatient Physician and Surgical Services50% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNot Applicable

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for Children0.00%
Eye Glasses for Children0.00%

Exclusions and Limitations

More Included BenefitsOutpatient 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
Other Practitioner Office Visit (Nurse, Physician Assistant)
Habilitation Services
Chiropractic Care
Durable Medical Equipment
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
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 Specialty Drugs
Chronic Pain Treatment
More Excluded BenefitsLong-Term/Custodial Nursing Home Care
Cosmetic Surgery
Hearing Aids
Routine Foot Care
Acupuncture
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $421
CareSource Marketplace Bronze
$7,700.00Select
from $447
my Blue Access WV EPO Bronze 7900
$7,900.00Select
from $468
my Blue Access WV EPO Bronze 7800 - 1 Free PCP Visit
$7,800.00Select
from $601
my Blue Access WV EPO Bronze 7900
$7,900.00Select
from $609
my Blue Access WV EPO Bronze 7800 - 1 Free PCP Visit
$7,800.00Select
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  • Phone Number
    (304) 388-1770
  • Office Locations
    830 Pennsylvania Ave Ste 202
    Charleston, WV 25302
830 Pennsylvania Ave Ste 202 Charleston WV, 25302

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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).