2018 (2018) Bronze MI04 HMO Plan Details - HealthPocket

(2018) Bronze MI04 HMO

$389.38/mo

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Zip Code90011
Applicant8/20/1983 Male
Coverage Start8/21/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan Name(2018) Bronze MI04 HMO
Plan IDhhs-64210CA0620004
Insurance ProviderSutter Health Plus
Metal LevelBronze
Plan TypeHMO
Deductible$6,300
Out-of-Pocket Maximum$7,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$75 Copay after deductible
Specialist Visit$105 Copay after deductible
Laboratory Outpatient and Professional Services$40 Copay
X-rays and Diagnostic Imaging100.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans100.00% Coinsurance after deductible
Deductible - Family$12600 per group
Out-of-Pocket Maximum - Family$14000 per group

Prescription drug coverage

Generic Drugs100.00% Coinsurance after deductible
Preferred Brand Drugs100.00% Coinsurance after deductible
Non-Preferred Brand Drugs100.00% Coinsurance after deductible
Specialty Drugs100.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttp://www.sutterhealthplus.org/providersearch/
Does this plan have access to a national provider network?No
Is a referral required to see a Specialist?Yes - All except OB/GYN
Does this plan cover services outside plan service area?Yes - Emergency and urgent care only
Does this plan cover services outside the country?Yes - Emergency and urgent care only

Hospital services

Emergency Room Services100.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)100.00% Coinsurance after deductible
Inpatient Physician and Surgical Services100.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service100.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal CareNo Charge
Delivery and all inpatient services for maternity care100.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$75 Copay after deductible
Mental/Behavioral Health Inpatient Services100.00% Coinsurance after deductible
Substance use disorder outpatient services$75 Copay after deductible
Substance use disorder inpatient services100.00% Coinsurance after deductible

Medical Management Programs

Does this plan offer disease managment programs?Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol
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
Acupuncture
Bariatric Surgery
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
Outpatient Rehabilitation Services
Habilitation Services
Durable Medical Equipment
Routine Foot Care
Abortion for Which Public Funding is Prohibited
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Nutritional Counseling
Prosthetic Devices
Radiation
Reconstructive Surgery
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
More Limited BenefitsSkilled Nursing Facility
Home Health Care Services
Hospice Services
Dental Check-Up for Children
More Excluded BenefitsCosmetic Surgery
Hearing Aids
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Chiropractic Care
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  • 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.

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