Zip Code | 19120 |
Applicant | 4/14/1986 Male |
Insurance Type | ACA (Obamacare) |
Plan Name | Personal Choice EPO Bronze Reserve |
Plan ID | qhp-31609PA0160005 |
Plan Year | 2020 |
Insurance Provider | Independence Blue Cross |
Metal Level | Expanded Bronze |
Plan Type | EPO |
Deductible | $6,900 |
Out-of-Pocket Maximum | $6,900 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | No Charge after Deductible |
Specialist Visit | No Charge after Deductible |
Laboratory Outpatient and Professional Services | No Charge after deductible |
X-rays and Diagnostic Imaging | No Charge after deductible |
Deductible - Family | $13800 |
Out-of-Pocket Maximum - Family | $13800 |
Prescription drug coverage | |
---|---|
Generic Drugs | No Charge after Deductible |
Preferred Brand Drugs | No Charge after Deductible |
Non-Preferred Brand Drugs | No Charge after Deductible |
Specialty Drugs | No Charge after Deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | http://www.ibx.com/individuals/find_provider/index.html |
Hospital services | |
---|---|
Emergency Room Services | No Charge after Deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | No Charge after Deductible |
Inpatient Physician and Surgical Services | No Charge after Deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | No Charge after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | No Charge after deductible |
Mental/Behavioral Health Inpatient Services | No Charge after deductible |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | No Charge |
Eye Glasses for Children | No Charge |
Exclusions and Limitations | |
---|---|
More Included Benefits | Reconstructive Surgery Dental Anesthesia Inherited Metabolic Disorder - PKU Telemedicine Diabetes Care Management 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 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 Nutritional Counseling |
More Excluded Benefits | Long-Term/Custodial Nursing Home Care Private-Duty Nursing Bariatric Surgery Cosmetic Surgery Hearing Aids Routine Foot Care Acupuncture Weight Loss Programs Abortion for Which Public Funding is Prohibited Treatment for Temporomandibular Joint Disorders |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $292 | UPMC Advantage Bronze $6,700/$0 - Standard Network | $6,700.00 | Select |
from $320 | Ambetter Essential Care 2 HSA (2021) | $6,900.00 | Select |
from $339 | Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental | $6,900.00 | Select |
from $362 | Personal Choice EPO Bronze Reserve | $7,000.00 | Select |
from $490 | Oscar Silver Classic Copay ($3 Prescription List + Free 24/7 Vi | $7,000.00 | Select |
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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 Benefytt Technologies, Inc. family of companies.
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