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Zip Code	04401 (edit)
Applicant	2/23/1984 Male (edit)
Coverage Start	2/24/2019 (edit)

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Insurance Type	ACA (Obamacare)
Plan Name	Anthem Bronze POS 6250 for HSA
Plan ID	hhs-48396ME0800058
Plan Year	2019
Insurance Provider	Anthem BCBS
Metal Level	Bronze
Plan Type	POS
Deductible	$6,250
Out-of-Pocket Maximum	$6,700
Personal Score
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	50.00% Coinsurance after deductible
Specialist Visit	50.00% Coinsurance after deductible
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	$12500 per group
Out-of-Pocket Maximum - Family	$13400 per group

Prescription drug coverage
Generic Drugs	50.00% Coinsurance after deductible
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	https://www.anthem.com/health-insurance/provider-directory/searchcriteria?brand=abcbs
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?	No - TRAD/PAR network
Does this plan cover services outside the country?	No - Urgent/Emergency Coverage Only

Hospital services
Emergency Room Services	$250 Copay after deductible, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
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	50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services	50.00% Coinsurance after deductible
Substance use disorder outpatient services	50.00% Coinsurance after deductible
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
Does this plan offer a wellness program?	Not Covered

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 Bariatric Surgery Imaging (CT/PET Scans, MRIs) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Home Health Care Services Durable Medical Equipment Hospice Services Dental Check-Up for Children Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Well Baby Visits and Care
More Limited Benefits	Skilled Nursing Facility Hearing Aids Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Cosmetic Surgery Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Weight Loss Programs Routine Foot Care Abortion for Which Public Funding is Prohibited Treatment for Temporomandibular Joint Disorders

+ See All Coverage Details

Premium

Plan Name

Deductible

from $289

Anthem Bronze X HMO 6350

$6,350.00

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from $300

Anthem Bronze X HMO 6250 for HSA

$6,250.00

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from $332

Anthem Bronze X HMO 6250 for HSA

$6,250.00

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from $333

Anthem Bronze HMO 6250 for HSA

$6,250.00

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from $353

Anthem Bronze X HMO 6350

$6,350.00

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Last Name

Location/Distance

Please select the correct zip

Bruno, Edwin

Mcguire, D

Castonguay, Bernard

Clark, Peggy

Phillips, Lewis

Macduffie, Heather

Olivos, Guillermo

Riley, James

Mansour, Anas

Nelson, Kathryn

Jameson, Mitchell

Maine Functional Medicine

Guerrette, Chandler

Madore, Nicole

Jamison, Tyler

Delusso, Joan

Winslow, Kelsey

Lifeworks Of Maine Llc

Makura, Zvorufura

Smith, Haley

Pierce, Jolene

Arno, Lindsey

Cyr, Katelyn

Edwin Bruno, D.P.M.

Phone Number
(207) 942-3988
Office Locations
277 State St
Bangor, ME 04401

What is a bronze plan?
Bronze Plan is a type of Metal Plan on the Health Insurance Marketplace. Bronze Plans qualify for Tax Credits and have low premiums. Generally speaking, a Bronze Plan is intended to have the lowest premium of the 4 new categories of health plans under the Affordable Care Act but charge the highest out-of-pocket costs for healthcare services.
How are Bronze Plans different than other Obamacare health plans?
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Bronze Plan pays 60% of the covered medical costs among its enrollees while the other Obamacare health plans pay a higher percentage of these costs.
How much does a Bronze Plan cost?
The monthly premium for a Bronze Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Bronze Plan premiums in your area. Another important factor to remember is Advanced Premium Tax Credits which can subsidize bronze plan premiums if an individual meets eligibility criteria.
When Can I Enroll in a Bronze Plan?
The annual enrollment period for the 2018 plan year will begin on November 1, 2017 and continue through December 15, 2017.
In 2015 there had been a Special Enrollment Period for many facing the uninsured penalty on their 2014 tax return. There is no guarantee that a similar Special Enrollment Period will be granted in 2017. See our Open Enrollment article for more information.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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Anthem Bronze POS 6250 for HSA

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