CGHC Value 1 Bronze $8700 Deductible (Allergy Testing+ Vision Exam) Plan Details for 2021- HealthPocket

CGHC Value 1 Bronze $8700 Deductible (Allergy Testing+ Vision Exam)

$341.71/mo

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Zip Code53215
Applicant5/19/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameCGHC Value 1 Bronze $8700 Deductible (Allergy Testing+ Vision Exam)
Plan IDhhs-87416WI0060014
Plan Year2021
Insurance ProviderCGHC
Metal LevelBronze
Plan TypeEPO
Deductible$8,700
Out-of-Pocket Maximum$8,700
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness0% Coinsurance after deductible
Specialist Visit0% Coinsurance after deductible
Laboratory Outpatient and Professional Services0% Coinsurance after deductible
X-rays and Diagnostic Imaging0% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans0% Coinsurance after deductible
Deductible - Family$17400 per group
Out-of-Pocket Maximum - Family$17400 per group

Prescription drug coverage

Generic Drugs0% Coinsurance after deductible
Preferred Brand Drugs0% Coinsurance after deductible
Non-Preferred Brand Drugs0% Coinsurance after deductible
Specialty Drugs0% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://portal.commongroundhealthcare.org/Router.jsp?
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?No -
Does this plan cover services outside plan service area?Yes - Emergency Services Only
Does this plan cover services outside the country?Yes - Emergency Services Only

Hospital services

Emergency Room Services0% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)0% Coinsurance after deductible
Inpatient Physician and Surgical Services0% Coinsurance after deductible
Emergency Transportation or Ambulance Service0% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care0% Coinsurance after deductible
Delivery and all inpatient services for maternity care0% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services0% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services0% Coinsurance after deductible
Substance use disorder outpatient services0% Coinsurance after deductible
Substance use disorder inpatient services0% 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, Pain Management, Pregnancy
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenCovered
Eye Glasses for ChildrenCovered
Routine Eye Exam for AdultsCovered

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 Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
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
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 BenefitsSkilled Nursing Facility
Hearing Aids
Home Health Care Services
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits
PremiumPlan NameDeductible
from $1,226QUARTZ ONE BRONZE I202 DIRECT-SA4$8,700.00Select
from $1,267Quartz One Silver I303 Direct-SA4$8,500.00Select
from $1,279QUARTZ ONE BRONZE I202 DIRECT WITH DENTAL-SA4$8,700.00Select
from $1,322Quartz One Silver I303 Direct With Dental-SA4$8,500.00Select
from $1,613QUARTZ ONE SILVER I303-SA4$8,500.00Select
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  • Phone Number
    (414) 672-1353
  • Office Locations
    2906 S 20th St
    Milwaukee, WI 53215
2906 S 20th St Milwaukee WI, 53215
  • What is a bronze plan?

    Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Generally speaking, a Bronze Plan is intended to have the lowest premium of the 4 new categories of health plans under the Affordable Care Act but charge the highest out-of-pocket costs for healthcare services.

  • How are Bronze 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 Bronze Plan pays 60% of the covered medical costs among its enrollees while the other Obamacare health plans pay a higher percentage of these costs.

  • How much does a Bronze Plan cost?

    The monthly premium for a Bronze 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 the region in which you live. You can use HealthPocket’s comparison tool to compare Bronze Plan premiums in your area. Another important factor to remember is Advanced Premium Tax Credits which can subsidize bronze plan premiums if an individual meets eligibility criteria.

  • When Can I Enroll in a Bronze Plan?

    The annual enrollment period for the 2018 plan year will begin on November 1, 2017 and continue through December 15, 2017.

    In 2015 there had been a Special Enrollment Period for many facing the uninsured penalty on their 2014 tax return. There is no guarantee that a similar Special Enrollment Period will be granted in 2017. See our Open Enrollment article for more information.

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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.