OptimaFit Bronze 7200 40% Direct Plan Details for 2021- HealthPocket

OptimaFit Bronze 7200 40% Direct

$384.34/mo

Apply For This Plan

Zip Code23464
Applicant9/18/1986 Male
Apply Now

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameOptimaFit Bronze 7200 40% Direct
Plan IDhhs-20507VA1410019
Plan Year2021
Insurance ProviderOptima Health
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$7,200
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$45 Copay, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit40.00% Coinsurance after deductible
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 scans40.00% Coinsurance after deductible
Deductible - Family$14400 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$20 Copay
Preferred Brand Drugs40.00% Coinsurance after deductible
Non-Preferred Brand Drugs45.00% Coinsurance after deductible
Specialty Drugs45.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://optimahealth.prismisp.com/
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?Yes - Emergency Only
Does this plan cover services outside the country?Yes - Emergency Only

Hospital services

Emergency Room Services50.00% Coinsurance 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 Services40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible
Substance use disorder outpatient services40.00% Coinsurance after deductible
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, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

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
Durable Medical Equipment
Hospice Services
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
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsSkilled Nursing Facility
Private-Duty Nursing
Home Health Care Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
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 $373Balance Bronze 3 No Copay Telehealth Visits$7,000.00Select
from $533Oscar Silver Classic Copay ($3 Prescription List + Free 24/7 Vi$7,000.00Select
/
Please select the correct zip
Charles, Fayton
View All Details
Reynaldo, Francisco
View All Details
Ravinder, Mohan
View All Details
Maxine, Beatty
View All Details
Eric, Jones
View All Details
Linda, Owen
View All Details
Rhonda, Osisek
View All Details
Kay, Peemoeller
View All Details
Alexandra, Saal
View All Details
Casey, Staidl
View All Details
Laura, Dobbs
View All Details
Emily, Stokke
View All Details
Jose, Paredes
View All Details
Leanna, Smith
View All Details
Rachel, Buechler
View All Details
Tamara, Tugung
View All Details
Taylor, Braegelman
View All Details
Atlantic Surgical Assistants, Inc
View All Details
Brenna, Fencil
View All Details
Allison, Taliaferro
View All Details
Amber, Scanlon
View All Details
Charles Fayton, M.D.
View All Details
  • Phone Number
    (757) 420-6218
  • Office Locations
    6477 College Park Sq
    Virginia Beach, VA 23464
6477 College Park Sq Virginia Beach VA, 23464

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.

Health Plans Found

 

HealthPocket.com provides information on insurance products. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Always review the privacy and terms of use of the partner website.

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.