Ambetter Essential Care 10 (2020) Plan Details for 2020- HealthPocket

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Zip Code03103
Applicant12/5/1984 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAmbetter Essential Care 10 (2020)
Plan IDqhp-75841NH0090010
Plan Year2020
Insurance ProviderCeltic Insurance Company
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$7,200
Out-of-Pocket Maximum$8,150
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% Coinsurance after deductible
X-rays and Diagnostic Imaging50% Coinsurance after deductible
Deductible - Family$14400
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs$20 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 URLhttp://ambetter.nhhealthyfamilies.com/findadoc

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%

Mental Health

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

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsRehabilitative 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
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Infertility Treatment
Urgent 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
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Routine Foot Care
More Excluded BenefitsAbortion for Which Public Funding is Prohibited
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Cosmetic Surgery
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
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  • Phone Number
    (603) 625-1864
  • Office Locations
    700 Lake Ave
    Manchester, NH 03103
700 Lake Ave Manchester NH, 03103

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).