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)

$364.53/mo
View BrochureSummary of BenefitsProvider Directory

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Zip Code33186
Applicant5/20/1987 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-68398FL0030031
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 Visit30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services$40 Copay
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans30.00% 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 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. The Network Area may include select Network providers located in a neighboring state.
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)30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services30.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service30.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care30.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible
Substance use disorder outpatient services30.00% Coinsurance after deductible
Substance use disorder inpatient services30.00% 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
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
Nutritional Counseling
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
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Dental Check-Up for Children
Chiropractic Care
Accidental Dental
Prosthetic Devices
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Private-Duty Nursing
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Long-Term/Custodial Nursing Home Care
PremiumPlan NameDeductible
from $297Oscar Bronze Simple ($3 Prescription List + Free 24/7 Virtual V$7,300.00Select
from $356Gym Access IND Bronze Standardized HMO$7,150.00Select
from $368Gym Access IND Bronze HMO 1041$7,200.00Select
from $454Ambetter Balanced Care 24 (2021)$7,450.00Select
from $472Ambetter Balanced Care 24 (2021) + Vision + Adult Dental$7,450.00Select
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  • Phone Number
    (305) 380-6773
  • Office Locations
    9000 Sw 137th Ave
    Miami, FL 33186
9000 Sw 137th Ave Miami FL, 33186

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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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