MySHL Solutions EPO Bronze 12 Plan Details for 2021- HealthPocket

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

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Zip Code	89110 (edit)
Applicant	6/26/1987 Male (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	MySHL Solutions EPO Bronze 12
Plan ID	hhs-83198NV0050017
Plan Year	2021
Insurance Provider	Golden Rule Insurance
Metal Level	Expanded Bronze
Plan Type	EPO
Deductible	$8,700
Out-of-Pocket Maximum	$8,700
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$50 Copay
Specialist Visit	$150 Copay
Laboratory Outpatient and Professional Services	$50 Copay
X-rays and Diagnostic Imaging	$120 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans	No Charge after deductible
Deductible - Family	$17400 per group
Out-of-Pocket Maximum - Family	$17400 per group

Prescription drug coverage
Generic Drugs	$30 Copay
Preferred Brand Drugs	$120 Copay
Non-Preferred Brand Drugs	No Charge after deductible
Specialty Drugs	50.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	http://myshlonline.com/body.cfm?id=25
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Yes - All
Does this plan cover services outside plan service area?	Yes - Urgent and Emergent
Does this plan cover services outside the country?	Not Covered

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	$100 Copay

Maternity
Prenatal and Postnatal Care	$50 Copay
Delivery and all inpatient services for maternity care	No Charge after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$50 Copay
Mental/Behavioral Health Inpatient Services	No Charge after deductible
Substance use disorder outpatient services	$50 Copay
Substance use disorder inpatient services	No Charge after deductible

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
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	Included
Child Dental Coverage - Basic Dental Care	Included
Child Dental Coverage - Orthodontia	Included
Child Dental Coverage - Major Dental Care	Included

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 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 Diabetes Care Management Inherited Metabolic Disorder - PKU 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 Clinical Trials Prescription Drugs Other Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Skilled Nursing Facility Bariatric Surgery Hearing Aids Infertility Treatment Outpatient Rehabilitation Services Habilitation Services Durable Medical Equipment Hospice Services Dental Check-Up for Children Chiropractic Care Nutritional Counseling Prosthetic Devices Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Cosmetic Surgery Weight Loss Programs Routine Foot Care Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $246	MyHPN Catastrophic Plan	$8,550.00	Select
from $248	MySHL Solutions EPO Catastrophic 1	$8,550.00	Select
from $254	Virtual HPN	$8,700.00	Select
from $257	Anthem Catastrophic Pathway Guided Access HMO 8550	$8,550.00	Select
from $267	MyHPN Plus Bronze 3	$8,700.00	Select

Last Name

Location/Distance

Please select the correct zip

Carlos, Ezpeleta

Ahmad, Saab

Richard, Orr

Chris, Nurre

Olivia, Yuson

Stephanneth, Adams

Rahul, Sharma

Paola, Diaz

Anais, Rodriguez

Anyi, Sepulveda

Thelma, Durbin

Jessica, Sanabria

Binh, Nguyen

New Mind Primary Care Clinic

Ronualdo, Robina

Kallee, Oxborrow

Logan, Klahn

Octavia, Maufas

Joseph, Santos

Elizabeth, Chapa

Laura, Girgash

Carlos Ezpeleta, M.D.

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Phone Number
(702) 383-6250
Office Locations
61 N. Nellis Blvd.
Las Vegas, NV 89110

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

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MySHL Solutions EPO Bronze 12

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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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MySHL Solutions EPO Bronze 12

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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