Healthy Premier Bronze HSA Plan Details for 2020- HealthPocket

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Zip Code84120
Applicant1/22/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHealthy Premier Bronze HSA
Plan IDqhp-42261UT0060003
Plan Year2020
Insurance ProviderUniversity of Utah Health Insurance Plans
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$6,900
Out-of-Pocket Maximum$6,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or IllnessNo Charge after Deductible
Specialist VisitNo Charge after Deductible
Laboratory Outpatient and Professional Services0.00%
X-rays and Diagnostic Imaging0.00%
Deductible - Family$13800
Out-of-Pocket Maximum - Family$13800

Prescription drug coverage

Generic DrugsNo Charge after Deductible
Preferred Brand DrugsNo Charge after Deductible
Non-Preferred Brand DrugsNo Charge after Deductible
Specialty DrugsNo Charge after Deductible

Access to doctors and hospitals

Provider directory URLhttps://app.healthcare.utah.edu/externalProviders/search?planId=9

Hospital services

Emergency Room ServicesNo Charge after Deductible
Inpatient Hospital Services (e.g., Hospital Stay)No Charge after Deductible
Inpatient Physician and Surgical ServicesNo Charge after Deductible

Maternity

Prenatal and Postnatal Care0.00%

Mental Health

Mental/Behavioral Health Outpatient Services0.00%
Mental/Behavioral Health Inpatient Services0.00%

Vision Coverage

Routine Eye Exam for Children0.00%
Eye Glasses for Children0.00%

Exclusions and Limitations

More Included BenefitsUrgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Skilled Nursing Facility
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Transplant
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Infusion Therapy
Reconstructive Surgery
Autism Spectrum Disorders
Inherited Metabolic Disorder - PKU
More Excluded BenefitsInfertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
Cosmetic Surgery
Chiropractic Care
Hearing Aids
Routine Foot Care
Acupuncture
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
Accidental Dental
Prosthetic Devices
Treatment for Temporomandibular Joint Disorders
Nutritional Counseling
PremiumPlan NameDeductible
from $188
Value Benchmark Bronze 6800
$6,800.00Select
from $196
Value HealthSave Expanded Bronze 6850 (HSA qualified)
$6,850.00Select
from $209
Core Care Bronze 1
$6,800.00Select
from $212
Healthy Preferred Bronze HSA
$6,900.00Select
from $212
Med Benchmark Bronze 6800
$6,800.00Select
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  • Phone Number
    (801) 924-0029
  • Office Locations
    3715 W 4100 S
    West Valley City, UT 84120
3715 W 4100 S West Valley City UT, 84120

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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

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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 Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).