2019 Health Net Bronze 60 EnhancedCare PPO Plan Details - HealthPocket

Health Net Bronze 60 EnhancedCare PPO

$0.00/mo

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Zip Code90011
Applicant11/15/1983 Male
Coverage Start11/17/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHealth Net Bronze 60 EnhancedCare PPO
Plan IDexch-CA2019HealthNetBronze60EnhancedCarePPO
Plan Year2019
Insurance ProviderHealth Net
Metal LevelBronze
Plan TypePPO
Deductible$6,300
Out-of-Pocket Maximum$7,550
Plan Highlights

Yearly Deductible & Out-of-Pocket

Yearly Deductible - Individual$6300
Yearly Deductible - Family$12600
Separate Drug Deductible - Individual$500
Separate Drug Deductible - Family$1000
Out-of-Pocket Max - Individual$7550
Out-of-Pocket Max - Family$15100
Maximum Cost per Prescription$500

Doctor Visit

Primary Care VisitFirst 3 visits at $75 Copay before deductible
Specialist Visit$105 Copay after deductible
Other Practitioner Office Visit$75 Copay after deductible
Preventive Care/Screening/ImmunizationNo Charge

Tests

Laboratory Tests$40 Copay
X-rays and Diagnostic Imaging100% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)100% Coinsurance after deductible

Drugs

Tier 1 (Most Generic Drugs)100% Coinsurance after deductible
Tier 2 (Preferred Brand Drugs)100% Coinsurance after deductible
Tier 3 (Non-Preferred Brand Drugs)100% Coinsurance after deductible
Tier 4 (Specialty Drugs)100% Coinsurance after deductible

Outpatient Services

Outpatient Facility Fee100% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services100% Coinsurance after deductible
Outpatient Services Office Visits100% Coinsurance after deductible

ER & Urgent Care

Emergency Room Facility Fee100% Coinsurance after deductible
Emergency Transportation100% Coinsurance after deductible
Urgent Care$75 Copay after deductible
Emergency Room Professional FeeNo Charge

Hospital

Inpatient Hospital Services100% Coinsurance after deductible
Inpatient Physician and Surgical Services100% Coinsurance after deductible

Mental/Behavioral Health

Mental/Behavioral Health Outpatient Services$75 Copay before deductible
Mental/Behavioral Health Inpatient Facility Fee100% Coinsurance after deductible
Mental/Behavioral Health Inpatient Professional Fee100% Coinsurance after deductible
Substance Use Disorder Outpatient Services$75 Copay before deductible
Substance Use Disorder Inpatient Facility Fee100% Coinsurance after deductible

Pregnancy

Prenatal CareNo Charge
Delivery and Maternity Care Inpatient Facility Fee100% Coinsurance after deductible
Delivery and Maternity Care Inpatient Professional Fee100% Coinsurance after deductible

Other Special Needs

Home Health Care Services100% Coinsurance after deductible
Outpatient Rehabilitation Services$75 Copay
Habilitation Services$75 Copay
Skilled Nursing Facility100% Coinsurance after deductible
Durable Medical Equipment100% Coinsurance after deductible
Hospice ServicesNo Charge
Acupuncture$75 Copay after deductible
Rehabilitative Speech Therapy$75 Copay
Rehabilitative Occupational and Rehabilitative Physical Therapy$75 Copay
Well Baby Visits and CareNo Charge
Allergy Testing$105 Copay after deductible
Diabetes EducationNo Charge
Nutritional CounselingNot covered

Children's Vision

Eye Exam for ChildrenNo Charge
Eyeglasses for ChildrenNo Charge

Children's Dental

Child Filling - One Surface20% Coinsurance
Child Dental CheckupNo Charge
Child Root Canal - Molar50% Coinsurance
Child Medically Necessary Orthodontia50% Coinsurance
PremiumPlan NameDeductible
from $346
Bronze 60 HMO
$6,300.00Select
from $348
Bronze 60 D EPO
$6,300.00Select
from $349
Bronze 60 PureCare HSP
$6,300.00Select
from $349
Bronze 60 HMO
$6,300.00Select
from $377
Advantage Bronze 6500 HDHP
$6,500.00Select
  • 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.

Read More

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.