2021 Bright Health Plan Catastrophic 3 $0 PCP Visits


Bright Health Illinois
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2021 Drug Formulary
$0 Rx List (including contraceptives)
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Overview

What is a Catastrophic Plan?

The Bright Health Catastrophic Plan has the lowest premiums of all the plans. This plan is best for those under the age of 30 who desire low premiums and expect minimal medical incidents. Coverage includes 3 primary care visits, then no other benefits until the maximum out-of-pocket ($8,550 individual / $17,100 family) is reached.

Bright Health Catastrophic 3 $0 PCP Visits

Download Summary of Benefits and Coverage here
Plan Guide here
Find a doctor here

Important Questions Answers Why this Matters:
What is the overall deductible?$8,550 Individual or
$17,100 Family
See the Common Medical Events chart below for your costs for services this plan covers.
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
Are there services covered before you meet your deductible?No. You will have to meet the deductible before the plan pays for any services.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other
deductibles for specific
services?
NoYou don’t have to meet deductibles for specific services
What is the out-of-pocket
limit for this plan?
$8,550 Individual or
$17,100 Family
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in
the out-of-pocket limit?
Premiums, balance-billed charges, and health care this plan doesn’t cover.Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider? Yes. See
https://brighthealthplan.com/provider-finder/ifp or call 1-855-827-4448 for a list of network providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to
see a specialist?
NoYou can see the specialist you choose without a referral.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider (You will pay the least)

Your cost if you use
a Non-Participating
Provider (You will pay the most)

Limitations & Exceptions, & Other Important Information
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$0 first 3 visits, then 0% after deductible

Not covered

None
Specialist visit

0%

Not covered

None
Preventive care/screening/immunization

No charge

Not covered

You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

Labs: 0%
X-rays: 0%

Not covered

Services require pre-authorization.
Imaging (CT / PET scans, MRIs)

0%

Not covered

Services require pre-authorization.
If you need drugs to treat
your illness or condition.
More information about
prescription drug coverage
is available at
www.brighthealthplan.com
Generic drugs (Tier 2)

0%

Not coveredTier 1 drugs are Preventive medications that are of $0 cost to you. Copays shown reflect the cost per retail prescription. Mail Order copays are 2.5 times the Retail cost.
Preferred brand drugs (Tier 3)

0%

Not covered
Non-preferred brand drugs
(Tier 4)

0%

Not covered

Specialty drugs (Tier5)

0%

Not covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

0%

Not covered

Services require pre-authorization.
Physician/surgeon fees

0%

Not covered

If you need immediate
medical attention
Emergency room care

0%

0%

None
Emergency medical transportation

0%

0%

None
Urgent care

0%

0%

None
If you have a hospital
stay
Facility fee (e.g., hospital room)

0%

Not covered

Services require pre-authorization.
Physician/surgeon fee

0%

Not covered

If you have mental
health, behavioral
health, or substance
abuse needs
Outpatient services0%

Not covered

None
Inpatient services

0%

Not covered

Services require pre-authorization.
If you are pregnantOffice visits

No charge

Not covered

Delivery stays exceeding 48 hours for vaginal delivery or 96 hours for a cesarean delivery require preauthorization.
Childbirth/delivery professional services

0%

Not covered

Delivery stays exceeding 48 hours for vaginal delivery or 96 hours for a cesarean delivery require preauthorization.
Childbirth/delivery facility
services

0%

Not covered

Delivery stays exceeding 48 hours for vaginal delivery or 96 hours for a cesarean delivery require preauthorization.
If you need help
recovering or have other special health needs
Home health care

0%

Not covered

Services require pre-authorization. Limited to 20 visits per calendar year. Services require pre-authorization. Limited to 35 combined visits per year for Occupational Therapy, Physical Therapy, Speech Therapy, and Chiropractic
Manipulations. Limited to 60 days per calendar year.
Services require pre-authorization.
Rehabilitation services

0%

Not covered

Habilitation services

0%

Not covered

Skilled nursing care

0%

Not covered

Durable medical equipment

0%

Not covered

Services require pre-authorization.
Hospice service0%

Not covered

Services require pre-authorization.
If your child needs
dental or eye care
Children’s eye exam

0%

Not covered

Limited to 1 eye exam per calendar year through the end of the month in which the dependent child turns19.
Children’s glasses

0%

Not covered

Limited to 1 pair of glasses including standard frames and standard lenses, or a one-year supply of contact lenses through the end of the month in which the dependent child turns 19.
Children’s dental check-up

0%

Not Covered

Includes diagnostic and preventive services for dependent children through the end of the month in which the dependent child turns 19. Refer to the policy for covered services and limitations.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Abortion (except in cases of rape, incest, or when the life of the mother is endangered)
  • Acupuncture
  • Dental care (Adults)
  • Hearing aids
  • Infertility treatment
  • Non-emergency care when traveling outside the U.S.
  • Private-duty nursing
  • Routine eye care (Adults)
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
  • Chiropractic care
  • Routine foot care (for diabetes)