Insurance Type | ACA (Obamacare) |
Plan Name | Ambetter Essential Care 5 (2021) |
Plan ID | hhs-91450AZ0080119 |
Plan Year | 2021 |
Insurance Provider | Health Net |
Metal Level | Expanded Bronze |
Plan Type | HMO |
Deductible | $8,100 |
Out-of-Pocket Maximum | $8,500 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $40 Copay |
Specialist Visit | $90 Copay |
Laboratory Outpatient and Professional Services | $45 Copay |
X-rays and Diagnostic Imaging | 50.00% Coinsurance after deductible |
Diagnostic Imaging such as MRIs, CT, and PET scans | 50.00% Coinsurance after deductible |
Deductible - Family | $16200 per group |
Out-of-Pocket Maximum - Family | $17000 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | $30 Copay |
Preferred Brand Drugs | 50.00% Coinsurance after deductible |
Non-Preferred Brand Drugs | 50.00% Coinsurance after deductible |
Specialty Drugs | 50.00% Coinsurance after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | https://ambetter.azcompletehealth.com/find-a-provider.html |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Not Covered |
Does this plan cover services outside plan service area? | Not Covered |
Does this plan cover services outside the country? | Not Covered |
Hospital services | |
---|---|
Emergency Room Services | 50.00% Coinsurance after deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | 50.00% Coinsurance after deductible |
Inpatient Physician and Surgical Services | 50.00% Coinsurance after deductible |
Emergency Transportation or Ambulance Service | 50.00% Coinsurance after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | $40 Copay |
Delivery and all inpatient services for maternity care | 50.00% Coinsurance after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | $40 Copay |
Mental/Behavioral Health Inpatient Services | 50.00% Coinsurance after deductible |
Substance use disorder outpatient services | $40 Copay |
Substance use disorder inpatient services | 50.00% Coinsurance after deductible |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Asthma, Diabetes, Heart Disease, Pregnancy |
Does this plan offer a wellness program? | Included |
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 | Not Covered |
Child Dental Coverage - Basic Dental Care | Not Covered |
Child Dental Coverage - Orthodontia | Not Covered |
Child Dental Coverage - Major Dental Care | Not Covered |
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 Routine Foot Care Diabetes Care Management Inherited Metabolic Disorder - PKU 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 Clinical Trials Off Label Prescription Drugs Prescription Drugs Other Wigs Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Mental/Behavioral Health Emergency Room Mental/Behavioral Health Emergency Transportation/Ambulance Mental/Behavioral Health ER Physician Fee Mental/Behavioral Health Outpatient Other Services Mental/Behavioral Health Urgent Care Substance Use Disorder Emergency Room Substance Use Disorder Emergency Transportation/Ambulance Substance Use Disorder ER Physician Fee Substance Use Disorder Outpatient Other Services Substance Use Disorder Urgent Care Telehealth and Virtual Care |
More Limited Benefits | Preventive Care/Screening/Immunization Skilled Nursing Facility Hearing Aids Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy |
More Excluded Benefits | Acupuncture Cosmetic Surgery Infertility Treatment Weight Loss Programs Dental Check-Up for Children Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $280 | Medica Pinnacle Bronze Value ($0 Virtual Care + Online Wellness) | $8,000.00 | Select |
from $347 | Cigna Connect 8000 | $8,000.00 | Select |
from $355 | Ambetter Essential Care 5 (2021) + Vision + Adult Dental | $8,100.00 | Select |
from $405 | Ambetter Balanced Care 32 | $8,100.00 | Select |
from $412 | Ambetter Essential Care 1 (2021) | $8,300.00 | 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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