Blue Cross Preferred HMO Bronze Saver HSA

Individual Health Insurance (Obamacare)

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Blue Cross Preferred HMO Bronze Saver HSA

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Monthly Cost

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Benefits & Coverage

Plan Name
Blue Cross Preferred HMO Bronze Saver HSA
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Metal Level
Expanded Bronze
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
Not Applicable
Specialist Visit
Not Applicable
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
$13300 per group
Out-of-Pocket Maximum - Family
$13300 per group

Prescription drug coverage

Generic Drugs
Not Applicable
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
http://www.bcbsm.com/index/find-a-doctor.html?utm_source=FindDoctorLeftNav.html
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Yes - All except routine OB/GYN & pediatric visits
Does this plan cover services outside plan service area?
Yes - Accidential Injury and Emergency Only
Does this plan cover services outside the country?
Yes - Accidential Injury and Emergency Only

Hospital services

Emergency Room Services
Not Applicable
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
Not Applicable
Delivery and all inpatient services for maternity care
No Charge after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
Not Applicable
Mental/Behavioral Health Inpatient Services
No Charge after deductible
Substance use disorder outpatient services
Not Applicable
Substance use disorder inpatient services
No Charge 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?
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
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
Infertility Treatment
Weight Loss Programs
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
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Non Preferred Specialty Drugs
Non Preferred Generic Drugs
More Limited Benefits
Skilled Nursing Facility
Bariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded Benefits
Acupuncture
Cosmetic Surgery
Hearing Aids
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Dental Check-Up for Children
Routine Foot Care
Abortion for Which Public Funding is Prohibited

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

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