Zip Code | 90011 |
Applicant | 1/22/1986 Male |
Insurance Type | ACA (Obamacare) |
Plan Name | SHARP Health Plan Bronze 60 Performance HMO |
Plan ID | exch-CA2020SHARPHealthPlanBronze60PerformanceHMO |
Plan Year | 2020 |
Insurance Provider | Sharp Health Plan |
Metal Level | Bronze HMO |
Plan Type | HMO |
Deductible | $0 |
Out-of-Pocket Maximum | $0 |
Plan Highlights |
Yearly Deductible & Out-of-Pocket | |
---|---|
Yearly Deductible - Individual | $6300 |
Yearly Deductible - Family | $12600 |
Separate Drug Deductible - Individual | $500 |
Separate Drug Deductible - Family | $1000 |
Out-of-Pocket Max - Individual | $7800 |
Out-of-Pocket Max - Family | $15600 |
Maximum Cost per Prescription | $500 |
Doctor Visit | |
---|---|
Primary Care Visit | First 3 visits at $65 Copay before deductible |
Specialist Visit | $95 Copay after deductible |
Other Practitioner Office Visit | $65 Copay after deductible |
Preventive Care/Screening/Immunization | No Charge |
Tests | |
---|---|
Laboratory Tests | $40 Copay |
X-rays and Diagnostic Imaging | 40% Coinsurance after deductible |
Imaging (CT/PET Scans, MRIs) | 40% Coinsurance after deductible |
Drugs | |
---|---|
Tier 1 (Most Generic Drugs) | $18 Copay after deductible |
Tier 2 (Preferred Brand Drugs) | 40% Coinsurance after deductible |
Tier 3 (Non-Preferred Brand Drugs) | 40% Coinsurance after deductible |
Tier 4 (Specialty Drugs) | 40% Coinsurance after deductible |
Outpatient Services | |
---|---|
Outpatient Facility Fee | 40% Coinsurance after deductible |
Outpatient Surgery Physician/Surgical Services | 40% Coinsurance after deductible |
Outpatient Services Office Visits | 40% Coinsurance after deductible |
ER & Urgent Care | |
---|---|
Emergency Room Facility Fee | 40% Coinsurance after deductible |
Emergency Transportation | 40% Coinsurance after deductible |
Urgent Care | $65 Copay after deductible |
Emergency Room Professional Fee | No Charge |
Hospital | |
---|---|
Inpatient Hospital Services | 40% Coinsurance after deductible |
Inpatient Physician and Surgical Services | 40% Coinsurance after deductible |
Mental/Behavioral Health | |
---|---|
Mental/Behavioral Health Outpatient Services | $65 Copay before deductible |
Mental/Behavioral Health Inpatient Facility Fee | 40% Coinsurance after deductible |
Mental/Behavioral Health Inpatient Professional Fee | 40% Coinsurance after deductible |
Substance Use Disorder Outpatient Services | $65 Copay before deductible |
Substance Use Disorder Inpatient Facility Fee | 40% Coinsurance after deductible |
Substance Use Disorder Inpatient Professional Fee | 40% Coinsurance after deductible |
Pregnancy | |
---|---|
Prenatal Care | No Charge |
Delivery and Maternity Care Inpatient Facility Fee | 40% Coinsurance after deductible |
Delivery and Maternity Care Inpatient Professional Fee | 40% Coinsurance after deductible |
Other Special Needs | |
---|---|
Home Health Care Services | 40% Coinsurance after deductible |
Outpatient Rehabilitation Services | $65 Copay |
Habilitation Services | $65 Copay |
Skilled Nursing Facility | 40% Coinsurance after deductible |
Durable Medical Equipment | 40% Coinsurance after deductible |
Hospice Services | No Charge |
Acupuncture | $65 Copay after deductible |
Rehabilitative Speech Therapy | $65 Copay |
Rehabilitative Occupational and Rehabilitative Physical Therapy | $65 Copay |
Well Baby Visits and Care | No Charge |
Allergy Testing | $95 Copay after deductible |
Diabetes Education | No Charge |
Nutritional Counseling | Not covered |
Children's Vision | |
---|---|
Eye Exam for Children | No Charge |
Eyeglasses for Children | No Charge |
Children's Dental | |
---|---|
Child Filling - One Surface | $25 Copay |
Child Dental Checkup | No Charge |
Child Root Canal - Molar | $300 Copay |
Child Medically Necessary Orthodontia | $1000 Copay |
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.