Sparrow PHP Bronze 6000 H.S.A. Exclusive

Individual Health Insurance (Obamacare)

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Sparrow PHP Bronze 6000 H.S.A. Exclusive

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Monthly Cost

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Benefits & Coverage

Plan Name
Sparrow PHP Bronze 6000 H.S.A. Exclusive
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Expanded Bronze
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
Not Applicable
Specialist Visit
Not Applicable
Laboratory Outpatient and Professional Services
Not Applicable
X-rays and Diagnostic Imaging
Not Applicable
Diagnostic Imaging such as MRIs, CT, and PET scans
Not Applicable
Deductible - Family
$12000 per group
Out-of-Pocket Maximum - Family
$12000 per group

Prescription drug coverage

Generic Drugs
Not Applicable
Preferred Brand Drugs
Not Applicable
Non-Preferred Brand Drugs
Not Applicable
Specialty Drugs
Not Applicable

Access to doctors and hospitals

Provider directory URL
http://www.phpmichigan.com/Members/Find-a-Doctor
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Not Covered
Does this plan cover services outside plan service area?
Yes - Coverage for emergency and urgent care only
Does this plan cover services outside the country?
Yes - Coverage for emergency and urgent care only

Hospital services

Emergency Room Services
Not Applicable
Inpatient Hospital Services (e.g., Hospital Stay)
Not Applicable
Inpatient Physician and Surgical Services
0.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
0.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care
0.00% Coinsurance after deductible
Delivery and all inpatient services for maternity care
0.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
Not Applicable
Mental/Behavioral Health Inpatient Services
Not Applicable
Substance use disorder outpatient services
Not Applicable
Substance use disorder inpatient services
Not Applicable

Medical Management Programs

Does this plan offer disease managment programs?
Asthma, Diabetes, 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
Not Covered

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
Dental Anesthesia
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Autism Spectrum Disorders
Clinical Trials
Mental Health - Intermediate
Substance Use Disorders - Intermediate
Telemedicine Services
More Limited Benefits
Skilled Nursing Facility
Bariatric Surgery
Outpatient Rehabilitation Services
Habilitation Services
Chiropractic Care
Nutritional Counseling
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
Routine Foot Care
Abortion for Which Public Funding is Prohibited

What To Know

  • This is an ACA (Obamacare) compliant health plan.

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