UHC Bronze-X Value+ ($3 Rx + 6 Free Virtual Visits) Plan Details for 2021- HealthPocket

UHC Bronze-X Value+ ($3 Rx + 6 Free Virtual Visits)

$255.52/mo

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Zip Code48228
Applicant7/3/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameUHC Bronze-X Value+ ($3 Rx + 6 Free Virtual Visits)
Plan IDhhs-71667MI0010012
Plan Year2021
Insurance ProviderGolden Rule Insurance
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$8,500
Out-of-Pocket Maximum$8,500
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$35 Copay
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$17000 per group
Out-of-Pocket Maximum - Family$17000 per group

Prescription drug coverage

Generic Drugs$3 Copay
Preferred Brand Drugs50.00% Coinsurance after deductible
Non-Preferred Brand Drugs50.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.uhc.com/find-a-physician
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All, except OBGYN and as state mandated
Does this plan cover services outside plan service area?Yes - Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area
Does this plan cover services outside the country?Not Covered

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
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 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
Infertility Treatment
Private-Duty Nursing
Weight Loss Programs
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
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)
More Limited BenefitsSkilled Nursing Facility
Bariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Dental Check-Up for Children
Chiropractic Care
Nutritional Counseling
Prosthetic Devices
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Hearing Aids
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Long-Term/Custodial Nursing Home Care
Eye Glasses - Adult
PremiumPlan NameDeductible
from $1,445MyPriority Bronze 8700 - Bronson Healthcare Partners$8,700.00Select
from $172HAP Personal Alliance HMO Genesys Choice Catastrophic 8550$8,550.00Select
from $199Blue Cross Preferred HMO Value$8,700.00Select
from $220McLaren Young Adult/Catastrophic$8,550.00Select
from $223MyPriority HMO Bronze 8550 - St. John Providence Network$8,550.00Select
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Please select the correct zip
William, Prechel
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Satish, Khanzode
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Physio Matrix Inc.
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Prince, Eubanks
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Prechel Family Clinic, Pc
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Juanita, Williams
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Halo Pediatrics
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Deidre, Flowers
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Javid, Khan
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Janet, Lang
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Iamerica Behavioral & Mental Health
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Wadeeah, Alshawi
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Deandra, Robinson
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Karen, Eddings-howell
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Vannessa, Robinson
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Mojtaba, Al-modhafir
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Taylor, Banks
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Joel, Shreve
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Briana, Lamar
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Roxsanna, Collins
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Roslyn, Mcgee
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William Prechel, D.O.
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  • Phone Number
    (313) 584-3624
  • Office Locations
    16551 W Warren Ave
    Detroit, MI 48228
16551 W Warren Ave Detroit MI, 48228

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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.