Insurance Type | ACA (Obamacare) |
Plan Name | Wellmark Bronze Traditional HMO |
Plan ID | hhs-25896IA0370005 |
Plan Year | 2021 |
Insurance Provider | Wellmark Blue Cross and Blue Shield |
Metal Level | Expanded Bronze |
Plan Type | HMO |
Deductible | $7,200 |
Out-of-Pocket Maximum | $8,500 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $75 Copay |
Specialist Visit | $150 Copay |
Laboratory Outpatient and Professional Services | 50.00% Coinsurance after deductible |
X-rays and Diagnostic Imaging | 50.00% Coinsurance after deductible |
Diagnostic Imaging such as MRIs, CT, and PET scans | 50.00% Coinsurance after deductible |
Deductible - Family | $14400 per group |
Out-of-Pocket Maximum - Family | $17000 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | $35 Copay |
Preferred Brand Drugs | 50.00% Coinsurance after deductible |
Non-Preferred Brand Drugs | 50.00% Coinsurance after deductible |
Specialty Drugs | 50.00% Coinsurance after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | http://www.wellmark.com |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Not Covered |
Does this plan cover services outside plan service area? | Yes - Accidental injury and emergency services only |
Does this plan cover services outside the country? | Yes - Accidental injury and emergency services only |
Hospital services | |
---|---|
Emergency Room Services | $950 Copay |
Inpatient Hospital Services (e.g., Hospital Stay) | 50.00% Coinsurance after deductible |
Inpatient Physician and Surgical Services | 50.00% Coinsurance after deductible |
Emergency Transportation or Ambulance Service | 50.00% Coinsurance after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | 50.00% Coinsurance after deductible |
Delivery and all inpatient services for maternity care | 50.00% Coinsurance after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | $75 Copay |
Mental/Behavioral Health Inpatient Services | 50.00% Coinsurance after deductible |
Substance use disorder outpatient services | $75 Copay |
Substance use disorder inpatient services | 50.00% Coinsurance after deductible |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Asthma, Depression, 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 | Not Covered |
Child Dental Coverage - Basic Dental Care | Not Covered |
Child Dental Coverage - Orthodontia | Not Covered |
Child Dental Coverage - Major Dental Care | Not Covered |
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 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 Outpatient Rehabilitation Services Habilitation Services Durable Medical Equipment Hospice Services Chiropractic Care Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
More Limited Benefits | |
More Excluded Benefits | Acupuncture Cosmetic Surgery Hearing Aids Weight Loss Programs Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Nutritional Counseling Long-Term/Custodial Nursing Home Care |
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.
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.
Quotes are provided by our partner. You are now leaving our site.