CareSource Marketplace HSA Eligible Bronze – HMO
Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: 60% coinsurance after deductible
Specialist visit: 60% coinsurance after deductible
Urgent care visit: 60% coinsurance after deductible
Description
Health Care Plan Details
Network type | HMO |
Deductible | $6,000 per person $6,000 per person |
Out-of-pocket max | $7,200 per person $14,400 per family |
Metal tier | Expanded Bronze |
Visit Copay
Primary care visit | 60% coinsurance after deductible |
Specialist visit | 60% coinsurance after deductible |
Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
Urgent care | 60% coinsurance after deductible |
Emergency room | 60% coinsurance after deductible |
Ambulance | 60% coinsurance after deductible |
Hospital stay (facility) | 60% coinsurance after deductible |
Hospital stay (physician) | 60% coinsurance after deductible |
Outpatient procedure (facility) | 60% coinsurance after deductible |
Outpatient procedure (physician) | 60% coinsurance after deductible |
Physical rehabilitation | 60% coinsurance after deductible |
Maternitowny and Pregnancy
Well baby care | No charge |
Labor, delivery, hospital stay | 60% coinsurance after deductible |
Pharmacy, Drugs, and Medication
Generic | 60% coinsurance after deductible |
Brand | 60% coinsurance after deductible |
Non-preferred Brand | 60% coinsurance after deductible |
Specialty | 60% coinsurance after deductible |
Lab Tests and Diagnostic Procedures
X-rays | 60% coinsurance after deductible |
Imaging (CT/PET/MRI) | 60% coinsurance after deductible |
Blood work | 60% coinsurance after deductible |
Mental and Psychiatric Health Care
Mental Health outpatient services | 60% coinsurance after deductible |
Psychiatric hospital stay | 60% coinsurance after deductible |
Health Plan Provider Information
Health Plan Benefits | https://www.caresource.com/documents/Marketplace-2024-GA-HSA-BronzeBase-Basic-sum.pdf |
Drug and medication plan formulary | https://www.caresource.com/documents/Marketplace-2024-GA-formulary |
Search doctor list | https://www.caresource.com/Find-A-Doctor-GA-MP |