Portfolio HSA HMO 6650 - Neighborhood Network
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | Portfolio HSA HMO 6650 - Neighborhood Network |
| Plan ID | hhs-53901AZ1420025 |
| 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 |
| 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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Bronze plan frequently asked questions (FAQ)
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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