Gym Access IND Bronze HMO BC 3841
$296.05/mo
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | Gym Access IND Bronze HMO BC 3841 |
| Plan ID | qhp-56503FL2530002 |
| Plan Year | 2019 |
| Insurance Provider | Florida Healthcare Plan |
| Metal Level | Expanded Bronze |
| Plan Type | HMO |
| Deductible | $6,400 |
| Out-of-Pocket Maximum | $7,900 |
| Plan Highlights |
Costs for Medical Care | |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $35 Copay |
| Specialist Visit | $65 Copay |
| Laboratory Outpatient and Professional Services | 50.00% Coinsurance after deductible |
| X-rays and Diagnostic Imaging | 50.00% Coinsurance after deductible |
| Deductible - Family | $12800 |
| Out-of-Pocket Maximum - Family | $15800 |
Prescription drug coverage | |
|---|---|
| Generic Drugs | $18 Copay |
| Preferred Brand Drugs | $65 Copay |
| Non-Preferred Brand Drugs | 50% Coinsurance after deductible |
| Specialty Drugs | 50% Coinsurance after deductible |
Access to doctors and hospitals | |
|---|---|
| Provider directory URL | Coming Soon |
Hospital services | |
|---|---|
| Emergency Room Services | 50% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay) | $100 Copay |
| Inpatient Physician and Surgical Services | No Charge after Deductible |
Maternity | |
|---|---|
| Prenatal and Postnatal Care | Not Applicable |
Mental Health | |
|---|---|
| Mental/Behavioral Health Outpatient Services | Not Applicable |
| Mental/Behavioral Health Inpatient Services | Not Applicable |
Vision Coverage | |
|---|---|
| Routine Eye Exam for Children | Not Applicable |
| Eye Glasses for Children | Not Applicable |
Exclusions and Limitations | |
|---|---|
| More Included Benefits | Hospice Services Reconstructive Surgery Diabetes Care Management Off Label Prescription Drugs Dental Anesthesia Congenital Anomaly, including Cleft Lip/Palate Bone Marrow Transplant Nutrition/Formulas Osteoporosis Gym Access Other Practitioner Office Visit (Nurse, Physician Assistant) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Home Health Care Services Inpatient Physician and Surgical Services Skilled Nursing Facility Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Durable Medical Equipment Imaging (CT/PET Scans, MRIs) Preventive Care/Screening/Immunization Rehabilitative Speech Therapy Rehabilitative Occupational and Rehabilitative Physical Therapy Well Baby Visits and Care Transplant Accidental Dental Dialysis Allergy Testing Chemotherapy Radiation Diabetes Education Prosthetic Devices Infusion Therapy Treatment for Temporomandibular Joint Disorders Nutritional Counseling |
| More Excluded Benefits | Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Bariatric Surgery Cosmetic Surgery Hearing Aids Routine Foot Care Acupuncture Weight Loss Programs Dental Check-Up for Children Abortion for Which Public Funding is Prohibited |
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