EverydayHealth HMO 6500 - Neighborhood Network

Individual Health Insurance (Obamacare)

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EverydayHealth HMO 6500 - Neighborhood Network

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Monthly Cost

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Benefits & Coverage

Plan Name
EverydayHealth HMO 6500 - Neighborhood Network
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
$30 Copay
Specialist Visit
$100 Copay
Laboratory Outpatient and Professional Services
10.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
10.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
10.00% Coinsurance after deductible
Deductible - Family
$13000 per group
Out-of-Pocket Maximum - Family
$14700 per group

Prescription drug coverage

Generic Drugs
$35 Copay
Preferred Brand Drugs
$100 Copay after deductible
Non-Preferred Brand Drugs
40.00% Coinsurance after deductible
Specialty Drugs
50.00% Coinsurance

Access to doctors and hospitals

Provider directory URL
https://www.azblue.com/individualsandfamilies/find-a-doctor
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Yes - You must select a network PCP and notify BCBSAZ of your selection. PCP referral required for all Specialists except OB/GYN, Chiropractors, Outpatient Behavioral Health providers, Urgent Care services and Emergency services.
Does this plan cover services outside plan service area?
Yes - Emergencies and Authorized Follow-up Care
Does this plan cover services outside the country?
Yes - Emergencies Only

Hospital services

Emergency Room Services
10.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
10.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
10.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
10.00% Coinsurance

Maternity

Prenatal and Postnatal Care
$100 Copay
Delivery and all inpatient services for maternity care
10.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$100 Copay
Mental/Behavioral Health Inpatient Services
10.00% Coinsurance after deductible
Substance use disorder outpatient services
$100 Copay
Substance use disorder inpatient services
10.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?
Asthma, Diabetes
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)
Bariatric Surgery
Private-Duty Nursing
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
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
More Limited Benefits
Preventive Care/Screening/Immunization
Skilled Nursing Facility
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Dental Check-Up for Children
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
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited

What To Know

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

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