Sutter Health Plans

Sutter Health Plans | Bronze Individual MI04

  • Bronze Individual MI04 is an Obamacare health insurance plan offered by Sutter Health Plans 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 $6,000. 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 $6,500, 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:
Bronze Individual MI04

Plan ID:

Plan Type:
HMO

Deductible:
$6,000

Maximum Out-of-Pocket:
$6,500

Summary of Benefits:

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.

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Highlights


Dental Coverage:
Child

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:
$70 copay per visit after deductible

Specialist Office Visit:
$90 copay per visit after deductible

Out of Network Coverage:
Not Covered

Out of Country Coverage:
Not Covered

Coverage Details

Preventive Care

Periodic Health Exam
In Network:
No Charge

Out of Network:
Not Applicable

Inpatient

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

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

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

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

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

Out of Network:
Not Applicable

Outpatient

Surgery
In Network:
No Charge after OOP Max is reached

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

Out of Network:
Not Applicable
Labs
In Network:
No Charge after OOP Max is reached

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

Out of Network:
Not Applicable
Mental Health
In Network:
$70 copay per visit after deductible

Out of Network:
Not Applicable

Maternity/Pregnancy

Pre & Postnatal Care
In Network:
No Charge

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

Out of Network:
Not Applicable

Dental

Basic Dental Care (Child)
In Network:
$25

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

Out of Network:
Not Applicable
Major Dental Care (Child)
In Network:
Covered, Varies by service

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

Out of Network:
Not Applicable

Vision

Eye Exam (Child)
In Network:
No Charge

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

Out of Network:
Not Applicable

Additional Coverage

Habilitation Services
In Network:
$70 copay per visit

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

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

Out of Network:
Not Applicable

Doctor Visits

Primary Care Visit
In Network:
$70 copay per visit after deductible

Out of Network:
Not Applicable
Specialist Visit
In Network:
$90 copay per visit after deductible

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

Out of Network:
Not Applicable

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:
$120 copay per visit after deductible

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

Out of Network:
Not Applicable

Drugs

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

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

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

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

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

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

Additional Plan Information

Summary Of Benefits:

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.

Sutter Health Plans All 2016 plans, rates, and benefits pending regulatory approval.

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