SHARP Health Plan Bronze 60 Performance HMO Plan Details for 2021- HealthPocket

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Applicant Info
Applicant
Date of birth
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Gender
male
female
Income
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Zip Code	90011 (edit)
Applicant	1/22/1986 Male (edit)

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

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Last Name

Location/Distance

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Carol, Thrun

Naeemah, Ghafur

John, Mull

Viveca, Hazboun

Siavash, Arani

Elizabeth, Rivera

Noemi, Paredes

Romyliza, Castillo

Mansi, Patel

Del Refugio Healthcare Inc

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Bennyt Productions, Llc

Tiffani, Mullen

Denise, La Lande

Clarence, Glenn

Tiana, Pastor

King's Point Foot And Ankle Specialist

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Nancy, Delgado

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Central Medical Clinic Inc

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Carol Thrun, MD

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Phone Number
(323) 918-2700
Office Locations
4800 S Central Ave
Los Angeles, CA 90011

4800 S Central Ave Los Angeles CA, 90011

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ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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SHARP Health Plan Bronze 60 Performance HMO

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Benefits & Coverage

Yearly Deductible & Out-of-Pocket

Doctor Visit

Tests

Drugs

Outpatient Services

ER & Urgent Care

Hospital

Mental/Behavioral Health

Pregnancy

Other Special Needs

Children's Vision

Children's Dental

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