Select Bronze 6900 Ded/6900 MOOP HSA Plan Details for 2020- HealthPocket

Select Bronze 6900 Ded/6900 MOOP HSA

$260.31/mo

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Zip Code53215
Applicant4/1/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameSelect Bronze 6900 Ded/6900 MOOP HSA
Plan IDqhp-94529WI0210045
Plan Year2020
Insurance ProviderGroup Health Cooperative of South Central Wisconsin
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$6,900
Out-of-Pocket Maximum$6,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or IllnessNo Charge after Deductible
Specialist VisitNo Charge after Deductible
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNo Charge after deductible
Deductible - Family$13800
Out-of-Pocket Maximum - Family$13800

Prescription drug coverage

Generic DrugsNo Charge after Deductible
Preferred Brand DrugsNo Charge after Deductible
Non-Preferred Brand DrugsNo Charge after Deductible
Specialty DrugsNo Charge after Deductible

Access to doctors and hospitals

Provider directory URLhttps://ghcscw.com/health-insurance/provider-directories

Hospital services

Emergency Room ServicesNo Charge after Deductible
Inpatient Hospital Services (e.g., Hospital Stay)No Charge after Deductible
Inpatient Physician and Surgical ServicesNo Charge after Deductible

Maternity

Prenatal and Postnatal CareNo Charge

Mental Health

Mental/Behavioral Health Outpatient ServicesNo Charge after deductible
Mental/Behavioral Health Inpatient ServicesNo Charge after deductible

Vision Coverage

Routine Eye Exam for ChildrenNo Charge after deductible
Eye Glasses for ChildrenNo Charge after deductible

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
Massage Therapy
Complementary Medicine
Cardiac Rehabilitation
Post-Cochlear Implant Aural Rehabilitation Therapy
Vision Rehabilitation Therapy
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
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Acupuncture
More Excluded BenefitsDental Check-Up for Children
Abortion for Which Public Funding is Prohibited
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Cosmetic Surgery
Routine Foot Care
Weight Loss Programs
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$6,800.00Select
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Daniel, Rosler
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Patricia, Cabral
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Robert, Ninneman
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William, Kraklow
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John, Hall
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Arshad, Jahangir
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Jaime, Yamat
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Ram P. Bhala, M.d., S.c.
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Alyssa, Deppong
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Christian, Garcia
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Daniel, Jacobsen
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Diane, Aranda
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Gabrielle, Chaumet
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Kate, Cruz
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Kimberly, Paulson
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Valerie, Duncan
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Riley, Marinelli
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Jessika, Kozik
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Amanda, Kanack
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Daniel Rosler, M.D.
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  • Phone Number
    (414) 672-8550
  • Office Locations
    2901 W Kinnickinnic River Pkwy
    Milwaukee, WI 53215
2901 W Kinnickinnic River Pkwy Milwaukee WI, 53215

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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).