Blue Cross Metro Detroit HMO Bronze Saver HSA Plan Details for 2021- HealthPocket

Blue Cross Metro Detroit HMO Bronze Saver HSA

$247.67/mo

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Zip Code48228
Applicant5/18/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Cross Metro Detroit HMO Bronze Saver HSA
Plan IDhhs-98185MI0440008
Plan Year2021
Insurance ProviderBlue Cross Blue Shield of Michigan
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$7,000
Out-of-Pocket Maximum$7,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or IllnessNot Applicable
Specialist VisitNot Applicable
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNo Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scansNo Charge after deductible
Deductible - Family$14000 per group
Out-of-Pocket Maximum - Family$14000 per group

Prescription drug coverage

Generic DrugsNot Applicable
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 URLhttp://www.bcbsm.com/index/find-a-doctor.html?utm_source=FindDoctorLeftNav.html
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All except routine OB/GYN & pediatric visits
Does this plan cover services outside plan service area?Yes - Accidential Injury and Emergency Only
Does this plan cover services outside the country?Yes - Accidential Injury and Emergency Only

Hospital services

Emergency Room ServicesNot Applicable
Inpatient Hospital Services (e.g., Hospital Stay)No Charge after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Emergency Transportation or Ambulance ServiceNo Charge after deductible

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity careNo Charge after deductible

Mental Health

Mental/Behavioral Health Outpatient ServicesNot Applicable
Mental/Behavioral Health Inpatient ServicesNo Charge after deductible
Substance use disorder outpatient servicesNot Applicable
Substance use disorder inpatient servicesNo Charge after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther 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
Durable Medical Equipment
Hospice Services
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Non-Preferred Specialty Drugs
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Non-Preferred Generic Durgs
More Limited BenefitsSkilled Nursing Facility
Bariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits[object Object]
PremiumPlan NameDeductible
from $1,540MyPriority HSA Bronze 7050 - Bronson Healthcare Partners$7,050.00Select
from $231MyPriority HMO HSA Bronze 7000 - St. John Providence Network$7,000.00Select
from $235HAP Personal Alliance HMO Genesys Choice Bronze 7000$7,000.00Select
from $240MyPriority HMO HSA Bronze 7000 - Beaumont Health Network$7,000.00Select
from $240MyPriority HMO HSA Bronze 7000 - St. Joseph Mercy Health System$7,000.00Select
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Please select the correct zip
William, Prechel
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Satish, Khanzode
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Physio Matrix Inc.
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Prince, Eubanks
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Prechel Family Clinic, Pc
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Juanita, Williams
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Halo Pediatrics
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Deidre, Flowers
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Javid, Khan
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Janet, Lang
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Iamerica Behavioral & Mental Health
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Wadeeah, Alshawi
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Deandra, Robinson
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Karen, Eddings-howell
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Vannessa, Robinson
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Mojtaba, Al-modhafir
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Taylor, Banks
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Joel, Shreve
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Briana, Lamar
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Roxsanna, Collins
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Roslyn, Mcgee
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William Prechel, D.O.
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  • Phone Number
    (313) 584-3624
  • Office Locations
    16551 W Warren Ave
    Detroit, MI 48228
16551 W Warren Ave Detroit MI, 48228

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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.