Ambetter Essential Care 4 HSA (2020) Plan Details for 2020- HealthPocket

Ambetter Essential Care 4 HSA (2020)

$269.10/mo

Apply For This Plan

Zip Code03103
Applicant1/24/1985 Male
Apply Now

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAmbetter Essential Care 4 HSA (2020)
Plan IDqhp-75841NH0090004
Plan Year2020
Insurance ProviderCeltic Insurance Company
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$5,400
Out-of-Pocket Maximum$6,750
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness30% Coinsurance after deductible
Specialist Visit30% Coinsurance after deductible
Laboratory Outpatient and Professional Services30% Coinsurance after deductible
X-rays and Diagnostic Imaging30% Coinsurance after deductible
Deductible - Family$10800
Out-of-Pocket Maximum - Family$13500

Prescription drug coverage

Generic Drugs30% Coinsurance after deductible
Preferred Brand Drugs30% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs40% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://ambetter.nhhealthyfamilies.com/findadoc

Hospital services

Emergency Room Services30% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30% Coinsurance after deductible
Inpatient Physician and Surgical Services30% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care30% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services30% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services30% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for ChildrenNot Applicable

Exclusions and Limitations

More Included BenefitsDurable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Routine Foot Care
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
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
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
Reconstructive Surgery
More Excluded BenefitsAcupuncture
Weight Loss Programs
Dental Check-Up for Children
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Cosmetic Surgery
Abortion for Which Public Funding is Prohibited
/
Please select the correct zip
Randy, Berube
View All Details
Robert, Feins
View All Details
Judson, Belmont
View All Details
Marc, Michaud
View All Details
Martin, Ginsberg
View All Details
Alison, Kirby
View All Details
Bethany, Hart
View All Details
Kelsie, Lagasse
View All Details
Lauren, Ahrens
View All Details
Andrew, Mustone
View All Details
Fleuresh Life Therapeutics Llc
View All Details
Kathleen, Niebrugge
View All Details
My Catholic Doctor, P.l.l.c.
View All Details
Nina, Incorvaia
View All Details
Makenna, Parker
View All Details
Alyssa, Kompelien
View All Details
Jon, Buchanan
View All Details
Rochelle, Gibney
View All Details
Ryan, Hirose
View All Details
Jennifer, Hamby
View All Details
Kristina, Hernandez
View All Details
Kimberly, Gagnon
View All Details
Randy Berube, PT
View All Details
  • 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).

Close

Health Plans Found

 

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).