Ambetter Bronze Plans

 

Apply Online Now

Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $6,800
Medical CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 0% Coinsurance
Prescription Drug Annual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. Integrated with medical deductible
Prescription Drug CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max Integrated with medical coinsurance
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services $6,800
Emergency Services
Emergency Room Services No charge after deductible
Emergency Transportation/Ambulance (Air or Ground) No charge after deductible
Urgent Care No charge after deductible
Provider Services
Annual Well Visit/Screening/Immunization/Well Baby No charge
Primary Care Visit to treat an injury or illness and Maternity No charge after deductible
Specialist Visit (e.g. Cardiology, Podiatry, Chiropractic Care) No charge after deductible
Imaging (CT/PET Scans, MRIs) No charge after deductible
X-rays & Diagnostic imaging No charge after deductible
Inpatient & Outpatient Services
Inpatient Facility Fee (Includes Mental Health, Substanc Use and Maternity) No charge after deductible
Inpatient Hospital Physician & Surgical Services No charge after deductible
Outpatient Facility Fee (e.g. Ambulatory Surgery Center) No charge after deductible
Outpatient Surgery Physician/Surgical Services No charge after deductible
Laboratory Outpatient & Professional Services No charge after deductible
Other Medical Services
Mental/Behavioral Health & Substance Use Disorder Outpatient Services No charge after deductible
Rehabilitation Outpatient Services (includes Speech, Occupational and Physical Therapy) No charge after deductible
Skilled Nursing Facility No charge after deductible
Pediatric Vision
Routine Eye Exam 100% covered
Eyeglasses 100% covered
Lenses 100% covered
Prescription Drugs
Generics $20 copay
Preferred Brand Drugs No charge after deductible
Non-preferred Brand Drugs No charge after deductible
Specialty Drugs No charge after deductible
Pediatric Vision
Exams and Eyewear:

Routine Eye Exam

100% Covered
Eyeglasses 100% Covered
Lenses (per pair):

Single

100% Covered
Bifocal 100% Covered
Trifocal 100% Covered
Lenticular 100% Covered
Contact Lenses:

Contact lenses (in lieu of glasses)

100% Covered
Contact lens fitting 100% Covered
Specialty lens fitting 100% Covered
Adult Vision
Exams and Eyewear:

Routine Eye Exam

100% Covered
Eyeglasses Covered up to $130
Lenses(per pair):

Single

100% Covered
Bifocal 100% Covered
Trifocal 100% Covered
Lenticular 100% Covered
Contact Lenses (in lieu of glasses) Covered up to $130
Contact lens fitting 100% Covered
Specialty lens fitting Covered up to $50
Adult Dental (Ages 19 years of age and older, does not include Pediatric Dental Coverage)
Annual Maximum Dental Benefit $1,000 per covered person per calendar year
Routine Dental
Routine Oral Exam No charge, subject to Annual Maximum
Routine Cleaning No charge, subject to Annual Maximum
Bite-wing X-ray No charge, subject to Annual Maximum
Full Mouth X-ray No charge, subject to Annual Maximum
Panoramic Film No charge, subject to Annual Maximum
Topical Fluoride Application No charge, subject to Annual Maximum
Palliative Treatment for relief of pain No charge, subject to Annual Maximum
Basic Dental
Basic Services:

Silver Fillings

50% coinsurance, subject to Annual Maximum
tooth Colored Fillings 50% coinsurance, subject to Annual Maximum
Endodontics:

Therapeutic Pulpotomy on permanent teeth

50% coinsurance, subject to Annual Maximum
Periodontics:

Scaling & Root Planning

50% coinsurance, subject to Annual Maximum
Periodontal Maintenance 50% coinsurance, subject to Annual Maximum
Oral Surgery:

Simple Extractions

50% coinsurance, subject to Annual Maximum
Surgical Extractions 50% coinsurance, subject to Annual Maximum
Removal of Impacted Teeth 50% coinsurance, subject to Annual Maximum
Alveoloplasty 50% coinsurance, subject to Annual Maximum
Prosthodontics:

Relines

50% coinsurance, subject to Annual Maximum
Rebase 50% coinsurance, subject to Annual Maximum
Adjustments 50% coinsurance, subject to Annual Maximum
Repairs 50% coinsurance, subject to Annual Maximum
Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $0
Medical CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 0% Coinsurance
Prescription Drug Annual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. Integrated with medical deductible
Prescription Drug CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max Integrated with medical coinsurance
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services $0
Emergency Services
Emergency Room Services No charge
Emergency Transportation/Ambulance (Air or Ground) No charge
Urgent Care No charge
Provider Services
Annual Well Visit/Screening/Immunization/Well Baby No charge
Primary Care Visit to treat an injury or illness and Maternity No charge
Specialist Visit (e.g. Cardiology, Podiatry, Chiropractic Care) No charge
Imaging (CT/PET Scans, MRIs) No charge
X-rays & Diagnostic imaging No charge
Inpatient & Outpatient Services
Inpatient Facility Fee (Includes Mental Health, Substanc Use and Maternity) No charge
Inpatient Hospital Physician & Surgical Services No charge
Outpatient Facility Fee (e.g. Ambulatory Surgery Center) No charge
Outpatient Surgery Physician/Surgical Services No charge
Laboratory Outpatient & Professional Services No charge
Other Medical Services
Mental/Behavioral Health & Substance Use Disorder Outpatient Services No charge
Rehabilitation Outpatient Services (includes Speech, Occupational and Physical Therapy) No charge
Skilled Nursing Facility No charge
Pediatric Vision
Routine Eye Exam 100% covered
Eyeglasses 100% covered
Lenses 100% covered
Prescription Drugs
Generics No charge
Preferred Brand Drugs No charge
Non-preferred Brand Drugs No charge
Specialty Drugs No charge
Pediatric Vision
Exams and Eyewear:

Routine Eye Exam

100% Covered
Eyeglasses 100% Covered
Lenses (per pair):

Single

100% Covered
Bifocal 100% Covered
Trifocal 100% Covered
Lenticular 100% Covered
Contact Lenses:

Contact lenses (in lieu of glasses)

100% Covered
Contact lens fitting 100% Covered
Specialty lens fitting 100% Covered
Adult Vision
Exams and Eyewear:

Routine Eye Exam

100% Covered
Eyeglasses Covered up to $130
Lenses(per pair):

Single

100% Covered
Bifocal 100% Covered
Trifocal 100% Covered
Lenticular 100% Covered
Contact Lenses (in lieu of glasses) Covered up to $130
Contact lens fitting 100% Covered
Specialty lens fitting Covered up to $50

Apply Online Now

Contact Us

New Enrollments:

Phone: (312) 726-6565
Email: [email protected]