2018 MyHPN Solutions HMO Bronze 7 Plan Details - HealthPocket

MyHPN Solutions HMO Bronze 7

$293.65/mo

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Zip Code89110
Applicant8/18/1983 Male
Coverage Start8/19/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMyHPN Solutions HMO Bronze 7
Plan IDhhs-95865NV0030070
Insurance ProviderHealth Plan of Nevada
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$6,500
Out-of-Pocket Maximum$7,350
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$50 Copay
Specialist Visit$100 Copay
Laboratory Outpatient and Professional Services$50 Copay
X-rays and Diagnostic Imaging$65 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans20.00% Coinsurance after deductible
Deductible - Family$13000 per group
Out-of-Pocket Maximum - Family$14700 per group

Prescription drug coverage

Generic Drugs$25 Copay
Preferred Brand Drugs$75 Copay after deductible
Non-Preferred Brand Drugs40.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.talispoint.com/sgh/external/hpn/
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All
Does this plan cover services outside plan service area?Yes - Urgent and Emergent
Does this plan cover services outside the country?Not Covered

Hospital services

Emergency Room Services$1000 Copay
Inpatient Hospital Services (e.g., Hospital Stay)0.00% Coinsurance after deductible
Inpatient Physician and Surgical Services20.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service0.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care$50 Copay
Delivery and all inpatient services for maternity care0.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$50 Copay
Mental/Behavioral Health Inpatient Services0.00% Coinsurance after deductible
Substance use disorder outpatient services$50 Copay
Substance use disorder inpatient services0.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?Included

Vision Coverage

Routine Eye Exam for ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareIncluded
Child Dental Coverage - Basic Dental CareIncluded
Child Dental Coverage - OrthodontiaIncluded
Child Dental Coverage - Major Dental CareIncluded

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
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
Home Health Care Services
Diabetes Care Management
Inherited Metabolic Disorder - PKU
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Clinical Trials
Prescription Drugs Other
More Limited BenefitsSkilled Nursing Facility
Bariatric Surgery
Hearing Aids
Infertility Treatment
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Hospice Services
Dental Check-Up for Children
Chiropractic Care
Nutritional Counseling
Prosthetic Devices
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
More Excluded BenefitsAcupuncture
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Weight Loss Programs
Routine Foot Care
Abortion for Which Public Funding is Prohibited
PremiumPlan NameDeductible
from $227
MyHPN Bronze 8
$6,600.00Select
from $243
MyHPN Bronze 7
$6,500.00Select
from $263
MySHL Solutions HSA EPO Bronze 3.1
$6,500.00Select
from $268
MySHL Solutions EPO Bronze 9
$6,600.00Select
from $278
MyHPN Bronze 8
$6,600.00Select

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