Navigator Bronze HSA 6900 Plan Details for 2021- HealthPocket

ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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Zip Code	97229 (edit)
Applicant	5/20/1987 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Navigator Bronze HSA 6900
Plan ID	hhs-10091OR0750002
Plan Year	2021
Insurance Provider	PacificSource Health Plans
Metal Level	Expanded Bronze
Plan Type	PPO
Deductible	$6,900
Out-of-Pocket Maximum	$6,900
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	No Charge after deductible
Specialist Visit	No Charge after deductible
Laboratory Outpatient and Professional Services	No Charge after deductible
X-rays and Diagnostic Imaging	No Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	No Charge after deductible
Deductible - Family	$13800 per group
Out-of-Pocket Maximum - Family	$13800 per group

Prescription drug coverage
Generic Drugs	No Charge after deductible
Preferred Brand Drugs	No Charge after deductible
Non-Preferred Brand Drugs	No Charge after deductible
Specialty Drugs	No Charge after deductible

Access to doctors and hospitals
Provider directory URL	https://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 Services	No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	No Charge after deductible
Inpatient Physician and Surgical Services	No Charge after deductible
Emergency Transportation or Ambulance Service	No Charge after deductible

Maternity
Prenatal and Postnatal Care	No Charge after deductible
Delivery and all inpatient services for maternity care	No Charge after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	No Charge after deductible
Mental/Behavioral Health Inpatient Services	No Charge after deductible
Substance use disorder outpatient services	No Charge after deductible
Substance use disorder inpatient services	No 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 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) 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 Benefits	Skilled Nursing Facility Acupuncture Cosmetic Surgery Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Bariatric 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

+ See All Coverage Details

Premium	Plan Name	Deductible
from $308	KP OR Bronze 6900/0% HSA	$6,900.00	Select
from $338	HSA Qualified 7000 Bronze - Choice Network	$7,000.00	Select
from $341	OHSU Health Silver 7000 Direct	$7,000.00	Select
from $344	Navigator Bronze 7000	$7,000.00	Select
from $385	SmartChoice Bronze HSA 6900	$6,900.00	Select

Last Name

Location/Distance

Please select the correct zip

Marilyn, Webber

Laura, Hardebeck

Gary, Geddes

Cynthia, Romero

Barbara, Liebowitz

Hadi Farah, Md, Llc

Dakota, Stewart

Sports Health Northwest Inc

Naviatric Llc

Tracy, Hill

Roberta, Mckenney

Ryan, Ross

Alexandra, Lodwig

Keri-kamryn, Skjei

Madeleine, Knutson

Mariah, Frank

Vernon, Rasmussen

Charles, Gregory

Amanda, Gangstead

April, Henderson

Katherine, Rinella

Adam, Howrey

Marilyn Webber, M.D.

Phone Number
(503) 629-0237
Office Locations
14223 Nw Spruceridge Ln
Portland, OR 97229

14223 Nw Spruceridge Ln Portland OR, 97229

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ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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Navigator Bronze HSA 6900

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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Navigator Bronze HSA 6900

Apply For This Plan

Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

Similar Plans

Physician Finder

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