Ambetter Value Bronze 5 Plan Details for 2021- HealthPocket

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Zip Code89110
Applicant8/8/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameAmbetter Value Bronze 5
Plan IDhhs-45142NV0070002
Plan Year2021
Insurance ProviderSilver Summit HealthPlan
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$8,300
Out-of-Pocket Maximum$8,700
Plan Highlights

Costs for Medical Care

Deductible - Family$16600 per group
Out-of-Pocket Maximum - Family$17400 per group

Access to doctors and hospitals

Provider directory URLhttp://ambetter.silversummithealthplan.com/findadoc
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All except for mental or behavioral health services, obstetrical or gynecological treatment.
Does this plan cover services outside plan service area?No - Except For Emergency
Does this plan cover services outside the country?Not Covered

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
Private-Duty Nursing
Imaging (CT/PET Scans, MRIs)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Home Health Care Services
Hospice Services
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
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
More Limited BenefitsSkilled Nursing Facility
Bariatric Surgery
Hearing Aids
Infertility Treatment
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Chiropractic Care
Nutritional Counseling
Prosthetic Devices
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits[object Object]
PremiumPlan NameDeductible
from $263MyHPN Solutions HMO Bronze 14$8,250.00Select
from $275MyHPN Bronze 12$8,250.00Select
from $279MySHL Solutions EPO Bronze 11$8,250.00Select
from $305Ambetter Essential Care 1 (2021)$8,300.00Select
from $320Ambetter Essential Care 1 (2021) + Vision + Adult Dental$8,300.00Select
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Carlos, Ezpeleta
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Chris, Nurre
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Olivia, Yuson
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Stephanneth, Adams
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Rahul, Sharma
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Paola, Diaz
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Anais, Rodriguez
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Anyi, Sepulveda
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Thelma, Durbin
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Jessica, Sanabria
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Binh, Nguyen
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New Mind Primary Care Clinic
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Ronualdo, Robina
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Kallee, Oxborrow
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Logan, Klahn
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Octavia, Maufas
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Joseph, Santos
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Elizabeth, Chapa
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Laura, Girgash
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Carlos Ezpeleta, M.D.
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  • Phone Number
    (702) 383-6250
  • Office Locations
    61 N. Nellis Blvd.
    Las Vegas, NV 89110
61 N. Nellis Blvd. Las Vegas NV, 89110

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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.