Bronze Copay Select 50 Plan Details for 2021- HealthPocket
Close ×

Bronze Copay Select 50

$1,003.46/mo
Summary of BenefitsProvider Directory

Apply For This Plan

Zip Code08701
Applicant6/27/1987 Male
Apply Now

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBronze Copay Select 50
Plan IDhhs-77263NJ0210001
Plan Year2021
Insurance ProviderGolden Rule Insurance
Metal LevelExpanded Bronze
Plan TypeEPO
Deductible$3,000
Out-of-Pocket Maximum$8,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness50.00% Coinsurance after deductible
Specialist Visit50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans50.00% Coinsurance after deductible
Deductible - Family$6000 per group
Out-of-Pocket Maximum - Family$17100 per group

Prescription drug coverage

Generic Drugs$15 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.oxhp.com
Does this plan have access to a national provider network?Yes
Is a referral required to see a Specialist?Yes - All specialists except for obstetricians and gynecologists.
Does this plan cover services outside plan service area?Not Covered
Does this plan cover services outside the country?Not Covered

Hospital services

Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care50.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care50.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Substance use disorder outpatient services50.00% Coinsurance after deductible
Substance use disorder inpatient services50.00% Coinsurance 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
Skilled Nursing Facility
Bariatric Surgery
Infertility Treatment
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
Durable Medical Equipment
Hospice Services
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
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 BenefitsHearing Aids
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Weight Loss Programs
Routine Foot Care
Diabetes Education
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $335Value Access Bronze$3,000.00Select
from $377IHC Bronze EPO Local Value $50/$75$3,000.00Select
from $381Oscar Bronze Classic (Free 24/7 Virtual Visits + Free Personal$3,000.00Select
/
Please select the correct zip
Jeffrey, Kaminetzky
View All Details
Jill, Sharon
View All Details
Sarah, Easaw
View All Details
Christopher, Zukowski
View All Details
Vaishali, Moghe
View All Details
Foot Health Centers, P.a.
View All Details
Ruchama, Schulman
View All Details
Chava, Schaum
View All Details
Cynthia, Birnbaum
View All Details
Yitzchok, Markovitz
View All Details
Gitel, Krupnik
View All Details
Shoshana, Markovitz
View All Details
Chana, Fishkind
View All Details
Mr Therapy Llc
View All Details
Rebecca, Bamberger
View All Details
Miriam, Baker
View All Details
Tzipora, Loewy
View All Details
Hannah, Sharit
View All Details
Debra, Schwartz
View All Details
Tsa Services Llc
View All Details
Michael, Bunzel
View All Details
Bracha, Levinson
View All Details
Jeffrey Kaminetzky, M.D.
View All Details
  • Phone Number
    (732) 364-2144
  • Office Locations
    1771 Madison Ave
    Lakewood, NJ 08701
1771 Madison Ave Lakewood NJ, 08701

Need an affordable alternative?

Are ACA plans too expensive for your budget? Consider Health
Benefit Indemnity Insurance through AgileHealthInsurance.comSee Plans Now!

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.

You are leaving HealthPocket

Quotes are provided by our partner. You are now leaving our site.

CancelLeave