Zip Code | 48228 |
Applicant | 1/25/1986 Male |
Insurance Type | ACA (Obamacare) |
Plan Name | MyPriority HMO Bronze 8150 |
Plan ID | hhs-29698MI0540320 |
Plan Year | 2020 |
Insurance Provider | Priority Health |
Metal Level | Expanded Bronze |
Plan Type | HMO |
Deductible | $8,150 |
Out-of-Pocket Maximum | $8,150 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $30 Copay |
Specialist Visit | Not Applicable |
Laboratory Outpatient and Professional Services | Not Applicable |
X-rays and Diagnostic Imaging | Not Applicable |
Diagnostic Imaging such as MRIs, CT, and PET scans | Not Applicable |
Deductible - Family | $16300 per group |
Out-of-Pocket Maximum - Family | $16300 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | $5 Copay |
Preferred Brand Drugs | Not Applicable |
Non-Preferred Brand Drugs | Not Applicable |
Specialty Drugs | Not Applicable |
Access to doctors and hospitals | |
---|---|
Provider directory URL | http://priorityhealth.prismisp.com/ |
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? | Yes - Urgent/Emergency Care Only |
Does this plan cover services outside the country? | Yes - Emergency Care Only |
Hospital services | |
---|---|
Emergency Room Services | Not Applicable |
Inpatient Hospital Services (e.g., Hospital Stay) | Not Applicable |
Inpatient Physician and Surgical Services | Not Applicable |
Emergency Transportation or Ambulance Service | Not Applicable |
Maternity | |
---|---|
Prenatal and Postnatal Care | Not Applicable |
Delivery and all inpatient services for maternity care | Not Applicable |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | $30 Copay |
Mental/Behavioral Health Inpatient Services | Not Applicable |
Substance use disorder outpatient services | $30 Copay |
Substance use disorder inpatient services | Not Applicable |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
Does this plan offer a wellness program? | Not Covered |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | Included |
Eye Glasses for Children | Included |
Routine Eye Exam for Adults | Included |
Child Dental Coverage | |
---|---|
Child Dental Coverage - Routine Dental Care | Not Covered |
Child Dental Coverage - Basic Dental Care | Not Covered |
Child Dental Coverage - Orthodontia | Not Covered |
Child Dental Coverage - Major Dental Care | Not Covered |
Adult Dental Coverage | |
---|---|
Adult Dental Coverage - Routine Dental Care | Not Covered |
Adult Dental Coverage - Basic Dental Care | Not Covered |
Adult Dental Coverage - Orthodontia | Not Covered |
Adult Dental Coverage - Major Dental Care | Not Covered |
Exclusions and Limitations | |
---|---|
More Included Benefits | Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Infertility Treatment Weight Loss Programs Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Home Health Care Services Durable Medical Equipment Applied Behavior Analysis Based Therapies Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Autism Spectrum Disorders Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
More Limited Benefits | Skilled Nursing Facility Bariatric Surgery Outpatient Rehabilitation Services Habilitation Services Hospice Services Chiropractic Care Nutritional Counseling Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy |
More Excluded Benefits | Acupuncture Cosmetic Surgery Hearing Aids Long-Term/Custodial Nursing Home Care Private-Duty Nursing Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Accidental Dental |
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.
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.