Engage LB600-IN21 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	33186 (edit)
Applicant	6/26/1987 Male (edit)

Insurance Type	ACA (Obamacare)
Plan Name	Engage LB600-IN21
Plan ID	hhs-19898FL0220006
Plan Year	2021
Insurance Provider	AvMed
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$6,500
Out-of-Pocket Maximum	$7,900
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$70 Copay
Specialist Visit	$140 Copay
Laboratory Outpatient and Professional Services	$40 Copay
X-rays and Diagnostic Imaging	$75 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	$250 Copay after deductible
Deductible - Family	$13000 per group
Out-of-Pocket Maximum - Family	$15800 per group

Prescription drug coverage
Generic Drugs	$25 Copay
Preferred Brand Drugs	$85 Copay
Non-Preferred Brand Drugs	50.00% Coinsurance after deductible
Specialty Drugs	40.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	https://www.avmed.org/web/individuals-families
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Yes - All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care.
Does this plan cover services outside plan service area?	Yes - Emergency Only
Does this plan cover services outside the country?	Yes - Emergency Only

Hospital services
Emergency Room Services	$500 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	$500 Copay per Stay after deductible
Inpatient Physician and Surgical Services	No Charge after deductible
Emergency Transportation or Ambulance Service	$200 Copay

Maternity
Prenatal and Postnatal Care	$70 Copay
Delivery and all inpatient services for maternity care	$500 Copay after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$70 Copay
Mental/Behavioral Health Inpatient Services	$500 Copay after deductible
Substance use disorder outpatient services	$70 Copay
Substance use disorder inpatient services	$500 Copay after deductible

Medical Management Programs
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	Included
Child Dental Coverage - Basic Dental Care	Included
Child Dental Coverage - Orthodontia	Included
Child Dental Coverage - Major Dental Care	Included

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 Imaging (CT/PET Scans, MRIs) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Durable Medical Equipment Hospice Services Non-Emergency Care When Traveling Outside the U.S. Dental Anesthesia Diabetes Care Management Accidental Dental 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 Bone Marrow Transplant Congenital Anomaly, including Cleft Lip/Palate Nutrition/Formulas Off Label Prescription Drugs Osteoporosis Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Skilled Nursing Facility Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Nutritional Counseling Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Bariatric Surgery Cosmetic Surgery Hearing Aids Infertility Treatment Long Term Care Private-Duty Nursing Weight Loss Programs Routine Foot Care Dental Care - Adult Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $325	Ambetter Balanced Care 203 (2021)	$6,450.00	Select
from $337	Ambetter Balanced Care 203 (2021) + Vision + Adult Dental	$6,450.00	Select
from $354	Gym Access IND Bronze HMO HSA 5065	$6,300.00	Select
from $361	UHC Bronze-X Value+ Saver ($5 Rx + 3 Free Primary Care & 6 Free Virtual Visits)	$6,350.00	Select
from $371	UHC Bronze-X Value+ ($3 Rx + 6 Free Virtual Visits)	$6,500.00	Select

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Phone Number
(305) 380-6773
Office Locations
9000 Sw 137th Ave
Miami, FL 33186

9000 Sw 137th Ave Miami FL, 33186

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

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HealthPocket.com is a free information source. 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. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.