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Zip Code	85364 (edit)
Applicant	2/22/1984 Male (edit)
Coverage Start	2/23/2019 (edit)

Insurance Type	ACA (Obamacare)
Plan Name	Portfolio HSA HMO 6650 - Neighborhood Network
Plan ID	hhs-53901AZ1420027
Plan Year	2018
Insurance Provider	Blue Cross Blue Shield of Arizona
Metal Level	Bronze
Plan Type	HMO
Deductible	$6,650
Out-of-Pocket Maximum	$6,650
Personal Score
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	$13300 per group
Out-of-Pocket Maximum - Family	$13300 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.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	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 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

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Premium

Plan Name

Deductible

from $228

Ambetter Essential Care 2 HSA (2019)

$6,550.00

Select

from $236

EverydayHealth HMO 6500 - PimaFocus Network

$6,500.00

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from $289

EverydayHealth HMO 6500 - PimaFocus Network

$6,500.00

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from $303

Bronze HSA

$6,750.00

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from $348

Ambetter Essential Care 2 HSA (2019)

$6,550.00

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Last Name

Location/Distance

Please select the correct zip

Berg, Gary

Patel, Kita

Plante, Mark

Luthra, Chaman

Secker, Vince

Karmakar, Kanka

Rizer, Lucas

Bruemmer, Dylan

Wilson, Ashlee

Shah, Noor

Abshire, Dylan

Cogswell, Shawn

Pineda, Wendy

Omole, Omotayo

Horner, Chelsea

Adam Z Ahmadi Md Pllc

View All Details

Peng, Xianhao

View All Details

Ombaire, Cyrus

View All Details

The Amistad Clinic, Pllc

Amb Medical, Plc

Conover, Rebecca

Coats, Brandon

Gary Berg, M.D.

Phone Number
(602) 273-6770
Office Locations
2400 S Ave A
Yuma, AZ 85364

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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Portfolio HSA HMO 6650 - Neighborhood Network

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Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

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Adult Dental Coverage

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