CareSource Marketplace HSA Eligible Bronze Plan Details for 2020- HealthPocket

CareSource Marketplace HSA Eligible Bronze

$469.72/mo

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Zip Code25302
Applicant7/2/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameCareSource Marketplace HSA Eligible Bronze
Plan IDqhp-50328WV0010020
Plan Year2020
Insurance ProviderCareSource
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,300
Out-of-Pocket Maximum$6,750
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness50% Coinsurance after deductible
Specialist Visit50% Coinsurance after deductible
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible
Deductible - Family$10600
Out-of-Pocket Maximum - Family$13500

Prescription drug coverage

Generic Drugs50% Coinsurance after deductible
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 Care50.00% Coinsurance after deductible

Mental Health

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

Vision Coverage

Routine Eye Exam for Children50.00% Coinsurance after deductible
Eye Glasses for Children50.00% Coinsurance after deductible

Exclusions and Limitations

More Included BenefitsUrgent 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
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
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
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 BenefitsCosmetic Surgery
Hearing Aids
Routine Foot Care
Acupuncture
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $492
CareSource Marketplace Low Deductible Silver
$5,100.00Select
from $510
CareSource Marketplace Low Deductible Silver Dental, Vision, & Fitness
$5,100.00Select
from $691
CareSource Marketplace HSA Eligible Bronze
$5,300.00Select
from $724
CareSource Marketplace Low Deductible Silver
$5,100.00Select
from $750
CareSource Marketplace Low Deductible Silver Dental, Vision, &
$5,100.00Select
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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).