Ambetter Essential Care 202 HSA Plan Details for 2021- HealthPocket

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Applicant Info
Applicant
Date of birth
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female
Income
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Zip Code	48228 (edit)
Applicant	5/19/1987 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Ambetter Essential Care 202 HSA
Plan ID	hhs-58594MI0050012
Plan Year	2021
Insurance Provider	Ambetter from Meridian
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$6,900
Out-of-Pocket Maximum	$6,900
Plan Highlights

Costs for Medical Care
Deductible - Family	$13800 per group
Out-of-Pocket Maximum - Family	$13800 per group

Access to doctors and hospitals
Provider directory URL	http://AmbetterMeridian.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?	Not Covered
Does this plan cover services outside the country?	Not Covered

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Diabetes, Heart Disease, Pregnancy
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	Not Covered

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 Habilitation Services Durable Medical Equipment Hospice Services 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 Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Mental/Behavioral Health Emergency Room Mental/Behavioral Health Emergency Transportation/Ambulance Mental/Behavioral Health ER Physician Fee Mental/Behavioral Health Outpatient Other Services Mental/Behavioral Health Urgent Care Substance Use Disorder Emergency Room Substance Use Disorder Emergency Transportation/Ambulance Substance Use Disorder ER Physician Fee Substance Use Disorder Outpatient Other Services Substance Use Disorder Urgent Care
More Limited Benefits	Skilled Nursing Facility Bariatric Surgery Outpatient Rehabilitation Services Chiropractic Care Nutritional Counseling Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	[object Object]

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Premium	Plan Name	Deductible
from $1,540	MyPriority HSA Bronze 7050 - Bronson Healthcare Partners	$7,050.00	Select
from $231	MyPriority HMO HSA Bronze 7000 - St. John Providence Network	$7,000.00	Select
from $235	HAP Personal Alliance HMO Genesys Choice Bronze 7000	$7,000.00	Select
from $240	MyPriority HMO HSA Bronze 7000 - Beaumont Health Network	$7,000.00	Select
from $240	MyPriority HMO HSA Bronze 7000 - St. Joseph Mercy Health System	$7,000.00	Select

Last Name

Location/Distance

Please select the correct zip

William, Prechel

Satish, Khanzode

Physio Matrix Inc.

Prince, Eubanks

Prechel Family Clinic, Pc

Juanita, Williams

Halo Pediatrics

Deidre, Flowers

Neo Inc.

Javid, Khan

Janet, Lang

Iamerica Behavioral & Mental Health

View All Details

Wadeeah, Alshawi

View All Details

Deandra, Robinson

View All Details

Karen, Eddings-howell

Vannessa, Robinson

Mojtaba, Al-modhafir

Taylor, Banks

Joel, Shreve

Briana, Lamar

Roxsanna, Collins

Roslyn, Mcgee

William Prechel, D.O.

View All Details

Phone Number
(313) 584-3624
Office Locations
16551 W Warren Ave
Detroit, MI 48228

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Date of birth
//
Gender
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Income
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Ambetter Essential Care 202 HSA

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Ambetter Essential Care 202 HSA

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Benefits & Coverage

Costs for Medical Care

Access to doctors and hospitals

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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