CGHC Value 2 Bronze $6000 Deductible (Allergy Testing+ Vision Exam) Plan Details for 2021- HealthPocket

CGHC Value 2 Bronze $6000 Deductible (Allergy Testing+ Vision Exam)

$351.54/mo

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Zip Code53215
Applicant5/19/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameCGHC Value 2 Bronze $6000 Deductible (Allergy Testing+ Vision Exam)
Plan IDhhs-87416WI0060017
Plan Year2021
Insurance ProviderCGHC
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$6,000
Out-of-Pocket Maximum$8,700
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay after deductible
Specialist Visit40% Coinsurance after deductible
Laboratory Outpatient and Professional Services40% Coinsurance after deductible
X-rays and Diagnostic Imaging40% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans40% Coinsurance after deductible
Deductible - Family$12000 per group
Out-of-Pocket Maximum - Family$17400 per group

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs40% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs40% 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 Services$1500 Copay after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40% Coinsurance after deductible
Inpatient Physician and Surgical Services40% Coinsurance after deductible
Emergency Transportation or Ambulance Service40% Coinsurance after deductible

Maternity

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

Mental Health

Mental/Behavioral Health Outpatient Services$30 Copay after deductible
Mental/Behavioral Health Inpatient Services40% Coinsurance after deductible
Substance use disorder outpatient services$30 Copay after deductible
Substance use disorder inpatient services40% 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 $335HMO HDHP Bronze 6000$6,000.00Select
from $361CGHC Value 2 Bronze $6000 Deductible (Dental Exam+ Allergy Testing+ Vision Exam)$6,000.00Select
from $369POS HDHP Bronze 6000$6,000.00Select
from $405WPS HMO HDHP Bronze $6,000 | Select Network$6,000.00Select
from $411MercyCare HMO Silver Option C$5,800.00Select
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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

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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.