Classic Bronze (Free 24/7 Telemedicine + Free Preventive Care) Plan Details for 2021- HealthPocket

Classic Bronze (Free 24/7 Telemedicine + Free Preventive Care)

$316.50/mo

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Zip Code85364
Applicant5/12/1986 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameClassic Bronze (Free 24/7 Telemedicine + Free Preventive Care)
Plan IDhhs-13877AZ0070003
Plan Year2020
Insurance ProviderOscar Health Plan, Inc.
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$5,500
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$50 Copay, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans50.00% Coinsurance after deductible
Deductible - Family$11000 per group
Out-of-Pocket Maximum - Family$16300 per group

Prescription drug coverage

Generic Drugs$3 Copay
Preferred Brand Drugs50.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.hioscar.com/search
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Not Covered
Does this plan cover services outside the country?Not Covered

Hospital services

Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care50.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$50 Copay, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Substance use disorder outpatient services$50 Copay, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder inpatient services50.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Bariatric Surgery
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Dental Check-Up for Children
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsPreventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $339Ambetter Balanced Care 29 (2021)$5,450.00Select
from $391Ambetter Balanced Care 29 (2021) + Vision + Adult Dental$5,450.00Select
from $393Ambetter Balanced Care 26 (2021)$5,450.00Select
from $409Cigna Connect 5500$5,500.00Select
from $411Ambetter Balanced Care 26 (2021) + Vision + Adult Dental$5,450.00Select
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Rajesh, Khona
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Kita, Patel
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Timothy, Graham
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Jay, Eldridge
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Donald, Runyan
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Shawn, Hermenau
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Nicolas, Santos
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Nnabuikem, Anaba
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Kailey, Rote
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Joseph, Sanchez
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Michael, Mccullagh
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Zachary, Parkinson
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Shanti Anesthesiology, Pllc
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Nafisah, Naqvi
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Stephanie, Clark
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Mina, Tawadrous
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Lee, Barnwell
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Marjorie, Bacon
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Jennifer, Mccumbee
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James, Lavin
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Kemell Health Llc
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Southwestern Palliative Care Associates Plc
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Rajesh Khona, M.D.
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  • Phone Number
    (602) 273-6770
  • Office Locations
    2400 S Avenue A
    Yuma, AZ 85364
2400 S Avenue A Yuma AZ, 85364

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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.