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

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

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Zip Code	48228 (edit)
Applicant	5/25/1987 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Blue Cross Select HMO Bronze Saver HSA
Plan ID	hhs-98185MI0440006
Plan Year	2021
Insurance Provider	Blue Cross Blue Shield of Michigan
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$7,000
Out-of-Pocket Maximum	$7,000
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	Not Applicable
Specialist Visit	Not Applicable
Laboratory Outpatient and Professional Services	No Charge after deductible
X-rays and Diagnostic Imaging	No Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	No Charge after deductible
Deductible - Family	$14000 per group
Out-of-Pocket Maximum - Family	$14000 per group

Prescription drug coverage
Generic Drugs	Not Applicable
Preferred Brand Drugs	No Charge after deductible
Non-Preferred Brand Drugs	No Charge after deductible
Specialty Drugs	No Charge after deductible

Access to doctors and hospitals
Provider directory URL	http://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 Services	Not Applicable
Inpatient Hospital Services (e.g., Hospital Stay)	No Charge after deductible
Inpatient Physician and Surgical Services	No Charge after deductible
Emergency Transportation or Ambulance Service	No Charge after deductible

Maternity
Prenatal and Postnatal Care	Not Applicable
Delivery and all inpatient services for maternity care	No Charge after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	Not Applicable
Mental/Behavioral Health Inpatient Services	No Charge after deductible
Substance use disorder outpatient services	Not Applicable
Substance use disorder inpatient services	No 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 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 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 Benefits	Skilled 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]

+ See All Coverage Details

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

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Blue Cross Select HMO Bronze Saver HSA

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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Blue Cross Select HMO Bronze Saver HSA

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

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