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

CareSource Marketplace Bronze Dental, Vision, & Fitness

$280.82/mo

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Zip Code46227
Applicant1/27/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameCareSource Marketplace Bronze Dental, Vision, & Fitness
Plan IDqhp-54192IN0020015
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://findadoctor.caresource.com/?programs=Indiana%20-%20Marketplace%20-%20Marketplace

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 BenefitsOther 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
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
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
Reconstructive Surgery
Non-Preferred Specialty Drugs
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Abortion for Which Public Funding is Prohibited
Routine Foot Care
Acupuncture
Weight Loss Programs
PremiumPlan NameDeductible
from $263
CareSource Marketplace Bronze
$7,700.00Select
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  • Phone Number
    (317) 887-7771
  • Office Locations
    8711 Us 31 S
    Indianapolis, IN 46227
8711 Us 31 S Indianapolis IN, 46227

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).

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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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).