Physicians Health Plan HMO Exclusive Bronze – HMO

Network type: HMO
Coverage tier: Expanded Bronze
Primary care visit: 50% coinsurance after deductible
Specialist visit: 50% coinsurance after deductible
Urgent care visit: 50% coinsurance after deductible

SKU: 60829MI0190030 Categories: Akron, Ann Arbor, Applegate, Argyle, Auburn, Bad Axe, Bancroft, Bannister, Bath, Bay City, Bay Port, Belding, Blanchard, Brant, Bridgeport, Brighton, Burt, Caro, Carrollton, Carson City, Carsonville, Caseville, Cass City, Chelsea, Chesaning, Clare, Clinton, Coral, Corunna, Croswell, Crystal, Dansville, Decker, Deckerville, Deford, Dewitt, Dexter, Dimondale, Durand, Eagle, East Lansing, Edmore, Elkton, Elsie, Essexville, Fairgrove, Farwell, Fenwick, Filion, Flushing, Forestville, Fowler, Frankenmuth, Gagetown, Gaines, Gowen, Grand Ledge, Grass Lake, Greenville, Gregory, Harbor Beach, Haslett, Henderson, Holt, Hubbardston, Ionia, Kawkawlin, Kinde, Kingston, Laingsburg, Lakeview, Lansing, Lennon, Leslie, Lexington, Linwood, Lyons, Manchester, Maple Rapids, Mason, Mcbrides, Melvin, Michigan, Minden City, Morley, Morrice, Mount Pleasant, Muir, Mulliken, Munger, New Lothrop, Oakley, Okemos, Orleans, Ovid, Owendale, Owosso, Palms, Palo, Peck, Pewamo, Pierson, Pigeon, Pinckney, Pinconning, Port Austin, Port Hope, Port Sanilac, Portland, Potterville, Reese, Riverdale, Rosebush, Ruth, Saginaw, Saint Charles, Saint Johns, Saline, Sandusky, Saranac, Sebewaing, Sheridan, Sidney, Six Lakes, Snover, Standish, Stanton, Sterling, Stockbridge, Sunfield, Trufant, Ubly, Unionville, University Center, Vassar, Vermontville, Vernon, Vestaburg, Weidman, Westphalia, Whitmore Lake, Whittaker, Williamston, Willis, Winn, Ypsilanti

Description

Description

Health Care Plan Details

Network type	HMO
Deductible	$6,500 per person $6,500 per person
Out-of-pocket max	$8,500 per person $17,000 per family
Metal tier	Expanded Bronze

Visit Copay

Primary care visit	50% coinsurance after deductible
Specialist visit	50% coinsurance after deductible
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	50% coinsurance after deductible
Emergency room	50% coinsurance after deductible
Ambulance	50% coinsurance after deductible
Hospital stay (facility)	50% coinsurance after deductible
Hospital stay (physician)	50% coinsurance after deductible
Outpatient procedure (facility)	50% coinsurance after deductible
Outpatient procedure (physician)	50% coinsurance after deductible
Physical rehabilitation	50% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	50% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$40 copay
Brand	50% coinsurance after deductible
Non-preferred Brand	50% coinsurance after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	50% coinsurance after deductible
Imaging (CT/PET/MRI)	50% coinsurance after deductible
Blood work	50% coinsurance after deductible

Mental and Psychiatric Health Care

Mental Health outpatient services	50% coinsurance after deductible
Psychiatric hospital stay	50% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.phpmichigan.com/upload/docs/ChoosePHPMI/SBCs/2024Plans/PHP_Excl_Bronze_OnMp_60829MI0190030-01_2024SBC_ENN088_RX09E650.pdf
Drug and medication plan formulary	https://www.phpmichigan.com/upload/docs/Providers/Pharmacy/Prescription-Drug-List-6-Tier-2024.pdf
Search doctor list	https://www.phpmichigan.com/upload/docs/Directories/2023/Exclusive%20Provider%20Directory%2008%2025%202023.pdf