Oscar Bronze Classic, ST3PCP, INN, Pediatric Dental, Dep29, Ste Plan Details for 2021- HealthPocket

Oscar Bronze Classic, ST3PCP, INN, Pediatric Dental, Dep29, Ste

$602.89/mo

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Zip Code11226
Applicant10/23/1986 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameOscar Bronze Classic, ST3PCP, INN, Pediatric Dental, Dep29, Ste
Plan IDhhs-74289NY2770011
Plan Year2021
Insurance ProviderOscar
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$4,700
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$50 Copay after deductible
Specialist Visit$75 Copay after deductible
Laboratory Outpatient and Professional Services$50 Copay after deductible
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans50.00% Coinsurance after deductible
Deductible - Family$9400 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$10 Copay after deductible
Preferred Brand Drugs$35 Copay after deductible
Non-Preferred Brand Drugs$70 Copay after deductible
Specialty DrugsNot Applicable

Access to doctors and hospitals

Provider directory URLhttp://www.hioscar.com/search
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 and Urgent Services 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)50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care50.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$50 Copay after deductible
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Substance use disorder outpatient services$50 Copay after deductible
Substance use disorder inpatient services50.00% 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?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 CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

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
Bariatric Surgery
Infertility Treatment
Weight Loss Programs
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Chiropractic Care
Applied Behavior Analysis Based Therapies
Cochlear Implants
Second Opinion
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
Breast Reconstructive Surgery
Cardiac Rehabilitation
Prostate Cancer Screening
Assistive Communication Devices
Autologous Blood Banking
Medical Supplies
Preadmission Testing
Design
Diabetic Equipment and Supplies
Family Planning Services
Sterilization Procedures for Men
Telemedicine
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Step Tracking
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Hospice Services
Dental Check-Up for Children
Inpatient Rehabilitation Services
Abortion for Which Public Funding is Prohibited
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Contact Lenses for Children
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Private-Duty Nursing
Routine Foot Care
Nutritional Counseling
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $138Fidelis Care Bronze for Children, Child Only, ST, INN, Fidelis$4,700.00Select
from $188Healthfirst Bronze Leaf, Child-Only, ST3PCP, INN, Pediatric Den$4,700.00Select
from $208HDHMO Non-Qualified 60, Bronze Child Only, ST3PCP, INN$4,700.00Select
from $214MVP Premier Bronze 2 Child Only, Child-Only, Expanded Bronze, S$4,700.00Select
from $220Bronze Standard Child Only ST3PCP ST INN$4,700.00Select
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Geo Medical Care P.c.
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Geo Medical Care P.c.
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  • Phone Number
    (718) 434-7545
  • Office Locations
    29 Newkirk Plz
    Brooklyn, NY 11226
29 Newkirk Plz Brooklyn NY, 11226

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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.