CHP TX Bronze HSA - Two Free PCP Visits Plan Details for 2020- HealthPocket

CHP TX Bronze HSA - Two Free PCP Visits

$302.24/mo

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Zip Code79936
Applicant7/11/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameCHP TX Bronze HSA - Two Free PCP Visits
Plan IDqhp-66252TX0080004
Plan Year2020
Insurance ProviderCHRISTUS Health Plan
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$6,000
Out-of-Pocket Maximum$6,850
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness40% Coinsurance after deductible
Specialist Visit40% Coinsurance after deductible
Laboratory Outpatient and Professional Services40% Coinsurance after deductible
X-rays and Diagnostic Imaging40% Coinsurance after deductible
Deductible - Family$12000
Out-of-Pocket Maximum - Family$13700

Prescription drug coverage

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

Access to doctors and hospitals

Provider directory URLhttps://www.christushealthplan.org/find-a-provider

Hospital services

Emergency Room Services40% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40% Coinsurance after deductible
Inpatient Physician and Surgical Services40% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care40% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services40% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services40% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNo Charge
Eye Glasses for ChildrenNo Charge

Exclusions and Limitations

More Included BenefitsOutpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Hearing Aids
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
Reconstructive Surgery
Diabetes Care Management
Autism Spectrum Disorders
Brain Injury
Transplant Donor Coverage
Post-Mastectomy Care
Off Label Prescription Drugs
Prescription Drugs Other
Pediatric Services Other
Inherited Metabolic Disorder - PKU
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Cosmetic Surgery
Routine Foot Care
Acupuncture
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
Nutritional Counseling
Mental Health Other
Newborn Hearing Screening
PremiumPlan NameDeductible
from $244
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Saver Bronze (Free 24/7 Telemedicine + Free Preventive Care)
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Ambetter Balanced Care 11 (2020)
$6,000.00Select
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Ambetter Balanced Care 11 (2020) + Adult Vision
$6,000.00Select
from $308
Ambetter Balanced Care 11 (2020) + Vision + Adult Dental
$6,000.00Select
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  • Phone Number
    (915) 225-3807
  • Office Locations
    11351 James Watt Dr
    El Paso, TX 79936
11351 James Watt Dr El Paso TX, 79936

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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).