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Zip Code	48228 (edit)
Applicant	2/18/1984 Male (edit)
Coverage Start	2/20/2019 (edit)

Insurance Type	ACA (Obamacare)
Plan Name	HAP Personal Alliance 5000 HMO Genesys Choice
Plan ID	hhs-37651MI0300006
Plan Year	2018
Insurance Provider	Health Alliance Plan
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$5,000
Out-of-Pocket Maximum	$7,350
Personal Score
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$30 Copay, 40.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Specialist Visit	40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging	40.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	40.00% Coinsurance after deductible
Deductible - Family	$10000 per group
Out-of-Pocket Maximum - Family	$14700 per group

Prescription drug coverage
Generic Drugs	$7 Copay
Preferred Brand Drugs	50.00% Coinsurance after deductible
Non-Preferred Brand Drugs	50.00% Coinsurance after deductible
Specialty Drugs	50.00% Coinsurance after deductible

Access to doctors and hospitals
Provider directory URL	http://www.choosehap.org/find-doctor
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Yes - Varies based on service and provider network; visit hap.org for details.
Does this plan cover services outside plan service area?	No - Urgent and emergency services only
Does this plan cover services outside the country?	No - Urgent and emergency services only

Hospital services
Emergency Room Services	40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service	40.00% Coinsurance after deductible

Maternity
Prenatal and Postnatal Care	40.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care	40.00% Coinsurance after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	$30 Copay
Mental/Behavioral Health Inpatient Services	40.00% Coinsurance after deductible
Substance use disorder outpatient services	$30 Copay
Substance use disorder inpatient services	40.00% Coinsurance 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, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?	Included

Vision Coverage
Routine Eye Exam for Children	Included
Eye Glasses for Children	Included
Routine Eye Exam for Adults	Included

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 Routine Foot Care 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 Telehealth Services
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 Non-Emergency Care When Traveling Outside the U.S. Abortion for Which Public Funding is Prohibited

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Premium

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from $250

Totally You - Value

$5,000.00

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Phone Number
(313) 584-3624
Office Locations
16551 W Warren Ave
Detroit, MI 48228

16551 W Warren Ave Detroit MI, 48228

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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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.