Benefits & Coverage
Plan Name
ENGAGE LB650-IN18
Plan ID
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Expanded Bronze
Plan Type
Deductible
Out-of-Pocket Maximum
Plan Highlights
Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness
No Charge after deductible
Specialist Visit
No Charge after deductible
Laboratory Outpatient and Professional Services
No Charge after deductible
X-rays and Diagnostic Imaging
No Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
No Charge after deductible
Deductible - Family
$14000 per group
Out-of-Pocket Maximum - Family
$14000 per group
Prescription drug coverage
Generic Drugs
No Charge after deductible
Preferred Brand Drugs
No Charge after deductible
Non-Preferred Brand Drugs
No Charge after deductible
Specialty Drugs
No Charge after deductible
Access to doctors and hospitals
Provider directory URL
https://www.avmed.org/web/individuals-families
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Yes - All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care.
Does this plan cover services outside plan service area?
Yes - Urgent/Emergent Only
Does this plan cover services outside the country?
Yes - Urgent/Emergent Only
Hospital services
Emergency Room Services
No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
No Charge after deductible
Inpatient Physician and Surgical Services
No Charge after deductible
Emergency Transportation or Ambulance Service
No Charge after deductible
Maternity
Prenatal and Postnatal Care
No Charge after deductible
Delivery and all inpatient services for maternity care
No Charge after deductible
Mental Health
Mental/Behavioral Health Outpatient Services
No Charge after deductible
Mental/Behavioral Health Inpatient Services
No Charge after deductible
Substance use disorder outpatient services
No Charge after deductible
Substance use disorder inpatient services
No Charge after deductible
Medical Management Programs
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
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
Durable Medical Equipment
Hospice Services
Routine Foot Care
Dental Anesthesia
Diabetes Care Management
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Bone Marrow Transplant
Congenital Anomaly, including Cleft Lip/Palate
Nutrition/Formulas
Osteoporosis
Preventive Care/Screening/Immunization
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
Durable Medical Equipment
Hospice Services
Routine Foot Care
Dental Anesthesia
Diabetes Care Management
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Bone Marrow Transplant
Congenital Anomaly, including Cleft Lip/Palate
Nutrition/Formulas
Osteoporosis
More Limited Benefits
Skilled Nursing Facility
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
Chiropractic Care
Nutritional Counseling
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits
Acupuncture
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
Bariatric Surgery
Cosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Abortion for Which Public Funding is Prohibited
What To Know
- This is an ACA (Obamacare) compliant health plan.
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