UHC Bronze-X Virtual First ($3 Rx + Unlimited Free App-based Care) (Disponible en espaol) Plan Details for 2021- HealthPocket
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UHC Bronze-X Virtual First ($3 Rx + Unlimited Free App-based Care) (Disponible en espaol)

$308.52/mo
View BrochureSummary of BenefitsProvider Directory

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Zip Code79936
Applicant6/25/1987 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameUHC Bronze-X Virtual First ($3 Rx + Unlimited Free App-based Care) (Disponible en espaol)
Plan IDhhs-40220TX0080012
Plan Year2021
Insurance ProviderGolden Rule Insurance
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$7,250
Out-of-Pocket Maximum$8,700
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$50 Copay
Specialist Visit50% Coinsurance after deductible
Laboratory Outpatient and Professional Services$75 Copay
X-rays and Diagnostic Imaging50% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans50% Coinsurance after deductible
Deductible - Family$14500 per group
Out-of-Pocket Maximum - Family$17400 per group

Prescription drug coverage

Generic Drugs$3 Copay
Preferred Brand Drugs30% Coinsurance after deductible
Non-Preferred Brand Drugs40% Coinsurance after deductible
Specialty Drugs50% 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?No -

Hospital services

Emergency Room Services50% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50% Coinsurance after deductible
Inpatient Physician and Surgical Services50% Coinsurance after deductible
Emergency Transportation or Ambulance Service50% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care50% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services50% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services50% Coinsurance after deductible
Substance use disorder outpatient services50% Coinsurance after deductible
Substance use disorder inpatient services50% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?
Does this plan offer a wellness program?Not Covered

Vision Coverage

Routine Eye Exam for ChildrenCovered
Eye Glasses for ChildrenCovered
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareCovered
Child Dental Coverage - Basic Dental CareCovered
Child Dental Coverage - OrthodontiaCovered
Child Dental Coverage - Major Dental CareCovered

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
Hospice Services
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited BenefitsSkilled Nursing Facility
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Dental Check-Up for Children
Chiropractic Care
Accidental Dental
Rehabilitative Occupational and Rehabilitative Physical Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Infertility Treatment
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Nutritional Counseling
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $290MyBlue Health Bronze? 402$7,400.00Select
from $319MyBlue Health Bronze 402$7,400.00Select
from $322Oscar Bronze Simple ($3 Prescription List + Free 24/7 Virtual V$7,300.00Select
from $461Ambetter Balanced Care 5 (2021)$7,350.00Select
from $466Ambetter Balanced Care 5 (2021) + Vision$7,350.00Select
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Huma, Lodhi
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Maria, Cardenas
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Patricia, Azarcon-samonte
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Thomas, Hoffer
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Nathaniel, Griffith
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Eep Internal Medicine Pa
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Stephanie, Moreno
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915 Pediatrics Pllc
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Isabel, Cano
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Sun Psychiatry Pllc
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Dc Gastro Konsult
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Stephanie Gonzalez Dpm Pa
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Patricia, Montiel Mendez
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Grace, Rodriguez
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Irving, Palacios Y Trejo
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Marisela, Gomez
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Alyson, Martinez
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Dawn, Sackett
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Erin, Ginithan
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Saranya, Gangupalli
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Elena, Paul
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Jose, Ruiz
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Huma Lodhi, M.D.
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  • Phone Number
    (915) 225-3807
  • Office Locations
    11351 James Watt Dr
    El Paso, TX 79936
11351 James Watt Dr El Paso TX, 79936

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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.

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