Insurance Type | ACA (Obamacare) |
Plan Name | Blue AdvanceHealth Bronze (4 Free Primary Care In-Person/Virtua |
Plan ID | hhs-53901AZ1420107 |
Plan Year | 2021 |
Insurance Provider | Blue Cross Blue Shield of Arizona |
Metal Level | Expanded Bronze |
Plan Type | HMO |
Deductible | $8,550 |
Out-of-Pocket Maximum | $8,550 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | No Charge after deductible |
Specialist Visit | No Charge after deductible |
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 | $17100 per group |
Out-of-Pocket Maximum - Family | $17100 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | $20 Copay |
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 | https://www.azblue.com/individualsandfamilies/find-a-doctor |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Yes - You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Physical Therapy, Occupational Therapy, Speech Therapy, Cognitive Therapy (PT, OT, ST, CT) and Cardiac and Pulmonary Rehabilitative and Habilitative Services, Pediatric Dental and Vision services, Telehealth and Urgent Care services, Walk-in Clinics, and Emergency services. |
Does this plan cover services outside plan service area? | Yes - Emergencies, Urgent Care and Authorized Follow-up Care. Urgent Care and Authorized Follow-up Care covered only through contracted providers. |
Does this plan cover services outside the country? | Yes - Emergencies Only. Authorization required for non-emergent services. |
Hospital services | |
---|---|
Emergency Room Services | No Charge after deductible |
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 | No Charge after deductible |
Delivery and all inpatient services for maternity care | No Charge after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | No Charge after deductible |
Mental/Behavioral Health Inpatient Services | No Charge after deductible |
Substance use disorder outpatient services | No Charge after deductible |
Substance use disorder inpatient services | No Charge 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) Bariatric Surgery Private-Duty Nursing 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 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 Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
More Limited Benefits | Preventive Care/Screening/Immunization Skilled Nursing Facility Hearing Aids Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Dental Check-Up for Children Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy |
More Excluded Benefits | Acupuncture Cosmetic Surgery Infertility Treatment Weight Loss Programs Routine Foot Care Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $258 | Oscar Secure (Free 24/7 Virtual Visits + Free Personal Care Tea | $8,550.00 | Select |
from $278 | Banner|AetnaBronze: Free 98point6 Virtual Care & MinuteClinic, CVS Store Discounts, Tucson | $8,700.00 | Select |
from $278 | Banner|AetnaBronze: Free 98point6 Virtual Care & MinuteClinic, CVS Store Discounts, Tucson, PD | $8,700.00 | Select |
from $308 | Banner|AetnaBronze: Free 98point6 Virtual Care & MinuteClinic, CVS Store Discounts, Phoenix | $8,700.00 | Select |
from $308 | Banner|AetnaBronze: Free 98point6 Virtual Care & MinuteClinic, CVS Store Discounts, Phoenix, PD | $8,700.00 | Select |
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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.
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