OptimaFit Bronze 7200 40% Direct M Plan Details for 2020- HealthPocket

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Zip Code23464
Applicant10/26/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameOptimaFit Bronze 7200 40% Direct M
Plan IDqhp-20507VA1410019
Plan Year2020
Insurance ProviderOptima Health
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$7,200
Out-of-Pocket Maximum$8,150
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 Services40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible
Deductible - Family$14400
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs40% Coinsurance after deductible
Non-Preferred Brand Drugs45% Coinsurance after deductible
Specialty Drugs45% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://optimahealth.prismisp.com/?icon-find-doctors=true

Hospital services

Emergency Room Services50% 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 Care40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNo Charge
Eye Glasses for ChildrenNo Charge

Exclusions and Limitations

More Included BenefitsRehabilitative 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
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Private-Duty Nursing
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
Rehabilitative Speech Therapy
Reconstructive Surgery
More Excluded BenefitsAbortion for Which Public Funding is Prohibited
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Routine Foot Care
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
PremiumPlan NameDeductible
from $305
Cigna Connect 7000
$7,000.00Select
from $320
Virginia Premier Preferred Bronze 7200
$7,200.00Select
from $328
Virginia Premier Preferred Bronze 7000
$7,000.00Select
from $385
Cigna Connect 7000
$7,000.00Select
from $391
Virginia Premier Preferred Bronze 7200
$7,200.00Select
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  • Phone Number
    (757) 420-6218
  • Office Locations
    6477 College Park Sq
    Virginia Beach, VA 23464
6477 College Park Sq Virginia Beach VA, 23464

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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.