Medica Individual Choice Bronze H S A Plan Details for 2020- HealthPocket

Medica Individual Choice Bronze H S A

$308.23/mo

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Zip Code53215
Applicant7/12/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMedica Individual Choice Bronze H S A
Plan IDqhp-57845WI0040011
Plan Year2020
Insurance ProviderMedica
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$6,400
Out-of-Pocket Maximum$6,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness20% Coinsurance after deductible
Specialist Visit20% Coinsurance after deductible
Laboratory Outpatient and Professional Services20.00% Coinsurance after deductible
X-rays and Diagnostic Imaging20.00% Coinsurance after deductible
Deductible - Family$12800
Out-of-Pocket Maximum - Family$13800

Prescription drug coverage

Generic Drugs20% Coinsurance after deductible
Preferred Brand Drugs20% Coinsurance after deductible
Non-Preferred Brand Drugs20% Coinsurance after deductible
Specialty Drugs30% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.medica.com/individualchoiceproviders

Hospital services

Emergency Room Services20% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)20% Coinsurance after deductible
Inpatient Physician and Surgical Services20% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care20.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services20.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services20.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for Children20.00% Coinsurance after deductible
Eye Glasses for Children20.00% Coinsurance 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
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient 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
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Durable Medical Equipment
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Treatment for Temporomandibular Joint Disorders
Reconstructive Surgery
More Excluded BenefitsDental Check-Up for Children
Abortion for Which Public Funding is Prohibited
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Cosmetic Surgery
Routine Foot Care
Acupuncture
Weight Loss Programs
Nutritional Counseling
PremiumPlan NameDeductible
from $292
Engage by Medica Bronze HSA
$6,400.00Select
from $346
Envision - Silver 6500/75
$6,500.00Select
from $349
HMO Bronze 6250 with 3 Free PCP Visits
$6,250.00Select
from $349
Constant Care Silver 2
$6,500.00Select
from $351
Atlas $6400 Plus Bronze
$6,400.00Select
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  • Phone Number
    (414) 672-1353
  • Office Locations
    2906 S 20th St
    Milwaukee, WI 53215
2906 S 20th St 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).