Sharp Health Plan

Sharp Health Plan | Sharp Bronze 60 HMO Network 2

  • Sharp Bronze 60 HMO Network 2 is an Obamacare health insurance plan offered by Sharp Health Plan that is available for individuals and families.

  • This plan is a HMO, meaning you will have to stay within the insurance company’s network, and will need to see a primary care doctor first and get a referral in order to see a specialist. (Read more about HMOs.)

  • This plan is a Bronze metal level plan, which generally has a lower monthly cost but higher annual deductible (and co-pay), and provides basic insurance coverage for people who do not spend regularly on health care (i.e., doctors, prescription drugs, etc.).

  • Deductible amount of $6,300. A deductible is the amount of healthcare costs you will pay on your own each year before the insurance company.

  • Max out-of-pocket of $6,800, which is the most you will pay in a plan year outside of premiums, out-of-network providers and non-essential health benefits.


Ways to Enroll or Learn More

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Plan Summary

Monthly Cost

Plan Name:
Sharp Bronze 60 HMO Network 2

Plan ID:
92499CA0020008

Plan Type:
HMO

Deductible:
$6,300

Maximum Out-of-Pocket:
$6,800

Provider Information:

Who is this plan for?

This plan with a lower monthly cost is great for healthy individuals and families who rarely, if ever, visit the doctor or use prescription drugs. The very high deductible on this plan means you will pay a significant amount of money of pocket for medical care and prescriptions before your insurance kicks in. The very high out-of-pocket maximum on this plan means you could be faced with a very expensive medical bill if an emergency happens. Plans with this type of provider network tend to have a narrower provider network.

HealthCare.com is a privately-held website for healthcare consumers operating since 2007. We’re not the government marketplace.

Highlights


Emergency Room:
No Charge after OOP Max is reached

Retail Drugs:
No Charge after OOP Max is reached

Generic Drugs:
No Charge after OOP Max is reached

Overview


Plan Type:
HMO

Metal Level:
Bronze

Health Spending Account:
No

Primary Care Office Visit:
$75 copay for first 3 visits, then full price until deductible is reached, then $75 copay per visit.

Specialist Office Visit:
$105 copay for first 3 visits, then full price until deductible is reached, then $105 copay per visit.

Out of Network Coverage:
No

Out of Country Coverage:
No

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
Not Covered
Well Baby Care
In Network:
No Charge

Out of Network:
Not Covered

Inpatient

Hospital Services
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Physician Fee
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Skilled Nursing Facility
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Mental Health
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Substance Abuse
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Home Healthcare
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered

Outpatient

Surgery
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
X-ray and Diagnostics
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Labs
In Network:
$40

Out of Network:
Not Covered
Facility Fee
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Mental Health
In Network:
$75 copay

Out of Network:
Not Covered
Substance Abuse
In Network:
$75 copay

Out of Network:
Not Covered
Rehabilitation Services
In Network:
$75

Out of Network:
Not Covered

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

Out of Network:
Not Covered
Labor and Delivery Inpatient Services
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered

Dental

Basic Dental Care (Child)
In Network:
$25

Out of Network:
Not Covered
Dental Checkup (Child)
In Network:
No Charge

Out of Network:
Not Covered
Major Dental Care (Child)
In Network:
$300

Out of Network:
Not Covered
Orthodontia (Child)
In Network:
$1,000

Out of Network:
Not Covered

Vision

Eye Exam (Child)
In Network:
No Charge

Out of Network:
Not Covered
Glasses (Child)
In Network:
No Charge

Out of Network:
Not Covered

Additional Coverage

Habilitation Services
In Network:
$75

Out of Network:
Not Covered
Rehabilitation Services (Speech)
In Network:
$75

Out of Network:
Not Covered
Rehabilitation Services (Occupational Therapy)
In Network:
$75

Out of Network:
Not Covered
Hospice Service
In Network:
No Charge

Out of Network:
Not Covered
Diabetes Care Management
In Network:
No Charge

Out of Network:
Not Covered
Durable Medical Equipment
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Reconstructive Surgery
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered

Doctor Visits

Primary Care Visit
In Network:
$75 copay for first 3 visits, then full price until deductible is reached, then $75 copay per visit.

Out of Network:
Not Covered
Specialist Visit
In Network:
$105 copay for first 3 visits, then full price until deductible is reached, then $105 copay per visit.

Out of Network:
Not Covered
Other Practitioner Office Visit
In Network:
$75 copay for first 3 visits, then full price until deductible is reached, then $75 copay per visit.

Out of Network:
Not Covered
Preventative Care / Screening / Immunization
In Network:
No Charge

Out of Network:
Not Covered

Emergency Room and Urgent Care

Emergency Room Services
In Network:
No Charge after OOP Max is reached

Out of Network:
No Charge after OOP Max is reached
Urgent Care Services
In Network:
$75 copay for first 3 visits, then full price until deductible is reached, then $75 copay per visit.

Out of Network:
Not Covered
Ambulance/Transportation Services
In Network:
No Charge after OOP Max is reached

Out of Network:
No Charge after OOP Max is reached

Drugs

Generic Prescription
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Retail Brand Drugs
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Non Retail Brand Drugs
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Specialty Drugs
In Network:
No Charge after OOP Max is reached

Out of Network:
Not Covered
Drug Deductible
In Network:
Individual: $500 Family: $1,000

Out of Network:
Individual: Not Applicable Family: Not Applicable

Additional Plan Information

Provider Information:

HealthCare.com is a privately owned website, and monthly costs shown above are estimates only. Your monthly premium may change based on the data provided, outside fees, optional benefits or if other factors take effect before your coverage start date. Note that insurance companies reserve the right to change your premium rate and the policy terms at any time. Effective date, benefit amounts and other conditions may apply at the discretion of the insurance carrier you select. Depending on your state of residence, this website may not display all plans available by state. The Obamacare Tax Subsidy Calculator amounts are estimates only and the actual amount of subsidy eligibility may differ. Access to your physician depends on network selected, and networks can change without notice. Contact your health insurance company to confirm your healthcare provider is still available in the network you select.

Important information about your Sharp Health Plan Click here to search for a Vision provider. Click here to search for a Dental provider. Click here for important information about Performance Network. Click here for important information about Premier Network. Out-of-Area Information Out-of-Area means services received while a Member is outside the Service Area. Out-of-Area coverage includes Urgent or Emergent services for the sudden onset of symptoms of sufficient severity to require immediate medical attention to prevent serious deterioration of a Member’s health resulting from unforeseen illness or injury or complication of an existing condition, including pregnancy, for which treatment cannot be delayed until the Member returns to the Service Area. Out-of-Area medical services will be covered to meet your immediate medical needs. Applicable follow-up for the Urgent or Emergent service must be Authorized by Sharp Health Plan and will be covered until it is prudent to transfer your care into the Plan’s Service Area. Exclusions and Limitations Information 1. Not Medically Necessary; 2. Not specifically described as covered in the Member Handbook or supplemental benefit materials; 3. In excess of the limits described in the Member Handbook or described in the Health Plan Benefits and Coverage Matrix; 4. Specified as excluded in the Member Handbook; 5. Not provided by Plan Providers (except for Emergency Services or Out-of-Area Urgent Care Services); 6. Not prescribed by a Plan Physician and, if required, Authorized in advance by your Primary Care Physician, your Plan Medical Group or the Plan (Note: Emergency Services do not require Authorization); 7. Part of a treatment plan for noncovered services; or 8. Received prior to the Member’s effective date of coverage or after the Member’s termination from coverage under this Plan FOR APPLICANTS 30 YEARS OLD AND OVER: You may be eligible for a Minimum Coverage plan if you are over the age of 30 and are able to provide a certification that you are without affordable coverage or are experiencing financial hardship. If so, please contact Sharp Health Plan for more information.

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