Blue Plus Minnesota Value Bronze $7000 Plan 203 Plan Details for 2021- HealthPocket

Blue Plus Minnesota Value Bronze $7000 Plan 203

$276.63/mo

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Zip Code55106
Applicant6/26/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Plus Minnesota Value Bronze $7000 Plan 203
Plan IDhhs-57129MN0530024
Plan Year2021
Insurance ProviderBlue Cross Blue Shield of Minnesota
Metal LevelExpanded Bronze
Plan TypePPO
Deductible$7,000
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$40 Copay, 25.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit$40 Copay, 25.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Laboratory Outpatient and Professional Services25.00% Coinsurance after deductible
X-rays and Diagnostic Imaging25.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans25.00% Coinsurance after deductible
Deductible - Family$14000 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs25.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs25.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.bluecrossmn.com/findadoctor
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 - Out of network benefits will be applied
Does this plan cover services outside the country?Yes - Out of network benefits will be applied

Hospital services

Emergency Room Services25.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)25.00% Coinsurance after deductible
Inpatient Physician and Surgical Services25.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service25.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care25.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$40 Copay, 25.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Mental/Behavioral Health Inpatient Services25.00% Coinsurance after deductible
Substance use disorder outpatient services$40 Copay, 25.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder inpatient services25.00% Coinsurance 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, Pregnancy
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
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Chiropractic Care
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Inpatient Physician and Surgical Services
Home Health Care Services
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $231PreferredHealth Expanded Bronze 27$7,000.00Select
from $234North Memorial Acclaim Bronze Copay$7,200.00Select
from $235Bold by M Health Fairview and Medica Bronze Copay$7,200.00Select
from $239UCare M Health Fairview Bronze HSA$7,050.00Select
from $240North Memorial Acclaim Bronze Copay (First 3)$6,850.00Select
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Midwest Innovative Neurodiagnostics Llp
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The Doctors Medical Clinic, P.a.
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Johnn Gaertner, M.D.
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  • Phone Number
    (651) 793-3100
  • Office Locations
    651 Arcade St
    Saint Paul, MN 55106
651 Arcade St Saint Paul MN, 55106

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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.