AmeriHealth Caritas Next Bronze Essential + No Referrals
AmeriHealth Caritas Next
Plan overview
Medical deductible
Individual: $10600
Family: $21200
Per Person: $10600
Prescription drug deductible
Individual: $0
Family: $0
Per Person: $0
Combined medical and drug out of pocket maximum
Individual: $10600
Family: $21200
Per Person: $10600
Office visit
Primary Doctor
CoPay: $25.00 Copay with deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Virtual care visits offered through AmeriHealth Caritas Next Virtual Care 24/7 are covered at No Charge, member deductible does not apply.
Specialist
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Dermatology virtual care visits offered through AmeriHealth Caritas Next Virtual Care 24/7 are covered at No Charge, member deductible does not apply. Additional information can be found on the member's schedule of benefits
Prescription drug information
Preferred brand drugs
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Certain off-label uses of cancer drugs will be covered in accordance with state law.
Non preferred brand drugs
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Certain off-label uses of cancer drugs will be covered in accordance with state law.
Generic drugs
CoPay: $25.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Certain off-label uses of cancer drugs will be covered in accordance with state law.
Specialty drugs
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Certain off-label uses of cancer drugs will be covered in accordance with state law.
Inpatient coverage
Hospital services
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Inpatient services
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Emergency and urgent care
Emergency room
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Urgent care facility
CoPay: $75.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Virtual care visits offered through AmeriHealth Caritas Next Virtual Care 24/7 are covered at No Charge, member deductible does not apply.
Maternity
Labor and delivery hospital stay
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Newborn must be covered for injury, sickness, or the cost of transporting the newborn to the nearest available facility that is appropriately stafffed. Coverage for transportation may not exceed the usual and customary charges, up to $1,000. Post partum assessment and newborn assessment must be performed.
Pre and Postnatal office visit
CoPay: No Charge
CoInsurance: Not Applicable
Covered: Covered
Vision
Routine Eye Exams for Children
CoPay: No Charge
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit: Exam(s) per Benefit Period
Major dental care
Routine dental checkups for children
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Routine dental checkups for adults
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
These policies have exclusions, limitations, reduction of benefits, terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable).