Ambetter Essential Care 10 (2021) + Vision Plan Details for 2021- HealthPocket

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County
Applicant Info
Applicant
Date of birth
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Gender
male
female
Income
$

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Zip Code	79936 (edit)
Applicant	3/1/1986 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Ambetter Essential Care 10 (2021) + Vision
Plan ID	hhs-29418TX0150030
Plan Year	2021
Insurance Provider	Ambetter
Metal Level	Expanded Bronze
Plan Type	EPO
Deductible	$0
Out-of-Pocket Maximum	$0
Plan Highlights

Access to doctors and hospitals
Provider directory URL	https://providersearch.ambetterhealth.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, High Blood Pressure & High Cholesterol, Low Back Pain, 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	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 Hearing Aids Infertility Treatment Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Durable Medical Equipment Hospice Services Routine Foot Care Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy 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 Telehealth and Virtual Care
More Limited Benefits	Skilled Nursing Facility Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Eyeglasses for Adults Eye Glasses for Adults
More Excluded Benefits	Acupuncture Bariatric Surgery Cosmetic Surgery Long Term Care Private-Duty Nursing Weight Loss Programs Dental Check-Up for Children Dental Care - Adult Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care

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Last Name

Location/Distance

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Huma, Lodhi

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Maria, Cardenas

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Patricia, Azarcon-samonte

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Thomas, Hoffer

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Nathaniel, Griffith

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Eep Internal Medicine Pa

Stephanie, Moreno

915 Pediatrics Pllc

Isabel, Cano

Sun Psychiatry Pllc

Dc Gastro Konsult

Stephanie Gonzalez Dpm Pa

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Patricia, Montiel Mendez

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Grace, Rodriguez

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Irving, Palacios Y Trejo

Marisela, Gomez

Alyson, Martinez

Dawn, Sackett

Erin, Ginithan

Saranya, Gangupalli

Elena, Paul

Jose, Ruiz

Huma Lodhi, M.D.

Phone Number
(915) 225-3807
Office Locations
11351 James Watt Dr
El Paso, TX 79936

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

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Ambetter Essential Care 10 (2021) + Vision

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Benefits & Coverage

Access to doctors and hospitals

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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