Sharp Bronze HMO

This plan are for those who are looking to comply with the individual mandate of the Affordable Care Act.

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Sharp Bronze HMO - Effective 2016
Health Insurance Plans for Individuals and Families

This plan are for those who are looking to comply with the individual mandate of the Affordable Care Act. Office visits are $60 for first 3 visits per calendar year prior to deductible, then $60 after the annual deductible is met.Sharp Bronze HMO Health Insurance There is an individual calendar deductible of $5,000 and a family deductible of $10,000. Most services require you to meet your calendar deductble first except preventive care services, such as routine physical exams and mammogram screenings, are at no charge. This is the most popular Sharp plan in California and will satisfy your mandated individual health insurance requirement also known as "minimum essential health coverage ".

Plan Name Bronze HMO
Combined Medical & Drug DeductibleIndividual: $5,000 Family: $10,000
Default Combined Medical & Drug Coinsurance 30%
Annual Out-of-Pocket
Out of Pocket Max for Med and Drug EHB Benefits (Total) Individual: $6,250 Family: $12,500
Emergency Health  
Urgent Care Centers or Facilities$120
Emergency Room Services$300 Copay after deductible
Emergency Transportation/Ambulance$300 Copay after deductible
Home Health Care
Home Health Care Services30% Coinsurance after deductible
Hospitalization Services
Inpatient Physician and Surgical Services30% Coinsurance after deductible
Habilitation Services30% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30% Coinsurance after deductible
Skilled Nursing Facility30% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services $60 Copay after deductible
Substance Abuse Disorder Inpatient Services30% Coinsurance after deductible
Maternity Care
Delivery and All Inpatient Services for Maternity Care30% Coinsurance after deductible
Prenatal and Postnatal CareNo Charge
Other Services
Mental/Behavioral Health Inpatient Services30% Coinsurance after deductible
Durable Medical Equipment30% Coinsurance after deductible
Hospice ServicesNo Charge
Bariatric Surgery30% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services $60 Copay after deductible
Acupuncture$60 Copay after deductible
Rehabilitative Speech Therapy30% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy30% Coinsurance after deductible
Abortion for Which Public Funding is Prohibited30% Coinsurance after deductible
Allergy Testing $70 Copay after deductible
Chemotherapy$60 Copay after deductible
Diabetes Education No charge
Dialysis30% Coinsurance after deductible
Infusion Therapy$60 Copay after deductible
Prosthetic Devices30% Coinsurance after deductible
Radiation$60 Copay after deductible
Reconstructive Surgery30% Coinsurance after deductible
Transplant 30% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders30% Coinsurance after deductible
Outpatient Services
Outpatient Surgery Physician/Surgical Services30% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)30% Coinsurance after deductible
Outpatient Rehabilitation Services30% Coinsurance after deductible
Prescription Drug Coverage
Generic Drugs $15 Copay after deductible
Non-Preferred Brand Drugs$75 Copay after deductible
Preferred Brand Drugs$50 Copay after deductible
Specialty Drugs 30% Coinsurance after deductible
Preventative Care
Well Baby Visits and CareNo Charge
Preventive Care/Screening/ImmunizationNo Charge
Professional Services
Other Practitioner Office Visit (Nurse, Physician Assistant) $60 Copay after deductible
Imaging (CT/PET Scans, MRIs)30% Coinsurance after deductible
X-rays and Diagnostic Imaging30% Coinsurance after deductible
Specialist Visit $70 Copay after deductible
Laboratory Outpatient and Professional Services30% Coinsurance after deductible
Primary Care Visit to Treat an Injury or Illness $60 Copay after deductible

Benefits stated above are using in network preferred providers only. Click here for provider information.

Information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage.

 

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