IDID Southwest Bronze 7300 Plan Details for 2021- HealthPocket

IDID Southwest Bronze 7300

$308.61/mo

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Zip Code83709
Applicant10/27/1986 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameIDID Southwest Bronze 7300
Plan IDhhs-61589ID2360120
Plan Year2021
Insurance ProviderBlue Cross of Idaho
Metal LevelExpanded Bronze
Plan TypePOS
Deductible$7,300
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$40 Copay
Specialist Visit$150 Copay
Laboratory Outpatient and Professional Services40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$500 Copay, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family$14600 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$25 Copay
Preferred Brand Drugs$30 Copay after deductible
Non-Preferred Brand Drugs$50 Copay after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.bcidaho.com/BCI_V2/prov_directory/prov_dir_criteria.aspx
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Yes - Allergy/Immunology, Audiologist, Cardiology, Cardiothoracic Surgery, Colorectal Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Gastroenterology, General Surgery, Hand Surgery, Hepatologist, Infectious Disease, Nephrology, Neurology, Neurosurgery, Oncology/Hematology, Oral Surgery, Ophthalmology, Orthopedics, Pain Management, Perinatologist, Plastic Surgery, Podiatry, Proctology, Psychiatry, Pulmonology, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery
Does this plan cover services outside plan service area?Yes - In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services.
Does this plan cover services outside the country?Yes - The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply.

Hospital services

Emergency Room Services$600 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service40.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care40.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care40.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$40 Copay
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible
Substance use disorder outpatient services$40 Copay
Substance use disorder inpatient services40.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, 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
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
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Nutritional Counseling
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Long Term Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Dental Care - Adult
Abortion for Which Public Funding is Prohibited
Treatment for Temporomandibular Joint Disorders
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $311KCN North Bronze 7300$7,300.00Select
from $314SAHA Southwest Bronze Connect 7300$7,300.00Select
from $329PQA Southeast Bronze Connect 7300$7,300.00Select
from $331CPN North Central Bronze 7300$7,300.00Select
from $337SLHP Bronze Essential 7500$7,500.00Select
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  • Phone Number
    (208) 302-5600
  • Office Locations
    10255 W. Overland Rd
    Boise, ID 83709
10255 W. Overland Rd Boise ID, 83709

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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.