2018 OMNIA Bronze HSA Plan Details - HealthPocket



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Zip Code08701
Applicant8/15/1983 Male
Coverage Start8/16/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameOMNIA Bronze HSA
Plan IDqhp-91661NJ2340001
Insurance ProviderHorizon Blue Cross Blue Shield of New Jersey
Metal LevelExpanded Bronze
Plan TypeEPO
Out-of-Pocket Maximum$6,550
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay
Specialist Visit$50 Copay
Deductible - Family$6000
Out-of-Pocket Maximum - Family$13100

Prescription drug coverage

Generic Drugs50% Coinsurance after deductible
Preferred Brand Drugs50% Coinsurance after deductible
Non-Preferred Brand Drugs50% Coinsurance after deductible
Specialty Drugs50% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLComing Soon

Hospital services

Emergency Room Services50% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)$500 Copay
Inpatient Physician and Surgical Services50% Coinsurance after deductible
PremiumPlan NameDeductible
from $251
IHC Bronze EPO HSA AmeriHealth Advantage $25/$50
from $266
IHC Bronze EPO HSA Tier 1 Advantage $50/$75
from $267
Classic Bronze
from $307
IHC Bronze EPO HSA AmeriHealth Advantage $25/$50
from $362

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