Blue HSA Gold Plan Details for 2021- HealthPocket

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Applicant Info
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Date of birth
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Income
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Zip Code	35215 (edit)
Applicant	3/6/1986 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Blue HSA Gold
Plan ID	hhs-46944AL0330001
Plan Year	2021
Insurance Provider	Blue Cross Blue Shield of Alabama
Metal Level	Gold
Plan Type	PPO
Deductible	$1,750
Out-of-Pocket Maximum	$6,000
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	10.00% Coinsurance after deductible
Specialist Visit	10.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	10.00% Coinsurance after deductible
X-rays and Diagnostic Imaging	10.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	10.00% Coinsurance after deductible
Deductible - Family	$3500 per group
Out-of-Pocket Maximum - Family	$12000 per group

Prescription drug coverage
Generic Drugs	10.00% Coinsurance after deductible
Preferred Brand Drugs	10.00% Coinsurance after deductible
Non-Preferred Brand Drugs	10.00% Coinsurance after deductible
Specialty Drugs	10.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	https://www.bcbsal.org/web/provider-finder
Does this plan have access to a national provider network?	Yes
Is a referral required to see a Specialist?	Not Covered
Does this plan cover services outside plan service area?	Yes - If a PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.
Does this plan cover services outside the country?	Yes - If a PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.

Hospital services
Emergency Room Services	10.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	10.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	10.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service	10.00% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	10.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care	10.00% Coinsurance after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	10.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	10.00% Coinsurance after deductible
Substance use disorder outpatient services	10.00% Coinsurance after deductible
Substance use disorder inpatient services	10.00% Coinsurance after deductible

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Diabetes, Heart Disease, Pregnancy
Does this plan offer a wellness program?	Included

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 Infertility Treatment 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 Home Health Care Services Durable Medical Equipment Hospice Services Non-Emergency Care When Traveling Outside the U.S. Accidental Dental Allergy Testing Chemotherapy Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Off Label Prescription Drugs Telephone and Online Video Physician Consultation Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Diabetes Education Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Skilled Nursing Facility Acupuncture Bariatric Surgery Cosmetic Surgery Hearing Aids Long Term Care Private-Duty Nursing Weight Loss Programs Routine Foot Care Dental Care - Adult Abortion for Which Public Funding is Prohibited Nutritional Counseling Long-Term/Custodial Nursing Home Care

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Last Name

Location/Distance

Please select the correct zip

Deborah, Peters

Michael, Powell

Rebecca, Dailey

Russell, Marsh

Fredred, Jones

Jsg Medical

Jeffrey, Jackson

Russell, Berry

Ann, Collins

Klayton, Barrows

Gary, Hodge

Phillip, Higginbotham

Andrew, Wilkins

Giuseppe, La Spina

Keonna, Farmer

Matthew, Mabery

Anna, Worth

Adam, Johnston

Christ Health Center Inc

View All Details

Hyewon, Lim

View All Details

Deborah Peters, MD

View All Details

Phone Number
(205) 833-6888
Office Locations
9772 Parkway E
Birmingham, AL 35215

What is the Gold Plan?
ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.
How are Gold Plans different than other Obamacare health plans?
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.
How much does a Gold Plan cost?
The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.
When Can I Enroll in a Gold Plan?
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.

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Applicant
Date of birth
//
Gender
male
female
Income
$

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Blue HSA Gold

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