Navigator Bronze HSA 6900 Plan Details for 2021- HealthPocket

Navigator Bronze HSA 6900

$339.00/mo

Apply For This Plan

Zip Code97229
Applicant5/20/1987 Male
Apply Now

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameNavigator Bronze HSA 6900
Plan IDhhs-10091OR0750002
Plan Year2021
Insurance ProviderPacificSource Health Plans
Metal LevelExpanded Bronze
Plan TypePPO
Deductible$6,900
Out-of-Pocket Maximum$6,900
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or IllnessNo Charge after deductible
Specialist VisitNo Charge after deductible
Laboratory Outpatient and Professional ServicesNo Charge after deductible
X-rays and Diagnostic ImagingNo Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scansNo Charge after deductible
Deductible - Family$13800 per group
Out-of-Pocket Maximum - Family$13800 per group

Prescription drug coverage

Generic DrugsNo Charge after deductible
Preferred Brand DrugsNo Charge after deductible
Non-Preferred Brand DrugsNo Charge after deductible
Specialty DrugsNo Charge after deductible

Access to doctors and hospitals

Provider directory URLhttps://www.pacificsource.com/find-a-provider/
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Not Covered
Does this plan cover services outside plan service area?Yes - In and out-of-network providers
Does this plan cover services outside the country?Yes - Emergency Care Only

Hospital services

Emergency Room ServicesNo Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)No Charge after deductible
Inpatient Physician and Surgical ServicesNo Charge after deductible
Emergency Transportation or Ambulance ServiceNo Charge after deductible

Maternity

Prenatal and Postnatal CareNo Charge after deductible
Delivery and all inpatient services for maternity careNo Charge after deductible

Mental Health

Mental/Behavioral Health Outpatient ServicesNo Charge after deductible
Mental/Behavioral Health Inpatient ServicesNo Charge after deductible
Substance use disorder outpatient servicesNo Charge after deductible
Substance use disorder inpatient servicesNo Charge 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 ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

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
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Durable Medical Equipment
Hospice Services
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Well Baby Visits and Care
Telehealth
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Tier 1 - Zero Cost-Share Preventive Drugs
Tier 2 - Preferred Generic Drugs
Tier 3 - Non-Preferred Generic Drugs
Tier 4 - Preferred Brand Drugs
Tier 5 - Non-Preferred Brand Drugs
Tier 6 - Preferred Specialty Drugs
Tier 7 - Non-Preferred Specialty Drugs
More Limited BenefitsSkilled Nursing Facility
Acupuncture
Cosmetic Surgery
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsBariatric Surgery
Infertility Treatment
Long Term Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Dental Care - Adult
Treatment for Temporomandibular Joint Disorders
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $308KP OR Bronze 6900/0% HSA$6,900.00Select
from $338HSA Qualified 7000 Bronze - Choice Network$7,000.00Select
from $341OHSU Health Silver 7000 Direct$7,000.00Select
from $344Navigator Bronze 7000$7,000.00Select
from $385SmartChoice Bronze HSA 6900$6,900.00Select
/
Please select the correct zip
Marilyn, Webber
View All Details
Laura, Hardebeck
View All Details
Gary, Geddes
View All Details
Cynthia, Romero
View All Details
Barbara, Liebowitz
View All Details
Hadi Farah, Md, Llc
View All Details
Dakota, Stewart
View All Details
Sports Health Northwest Inc
View All Details
Naviatric Llc
View All Details
Tracy, Hill
View All Details
Roberta, Mckenney
View All Details
Ryan, Ross
View All Details
Alexandra, Lodwig
View All Details
Keri-kamryn, Skjei
View All Details
Madeleine, Knutson
View All Details
Mariah, Frank
View All Details
Vernon, Rasmussen
View All Details
Charles, Gregory
View All Details
Amanda, Gangstead
View All Details
April, Henderson
View All Details
Katherine, Rinella
View All Details
Adam, Howrey
View All Details
Marilyn Webber, M.D.
View All Details
  • Phone Number
    (503) 629-0237
  • Office Locations
    14223 Nw Spruceridge Ln
    Portland, OR 97229
14223 Nw Spruceridge Ln Portland OR, 97229

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.