UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - 69842LA0240024 Health Insurance Plan
UnitedHealthcare Insurance Company health insurance plan with the Plan ID 69842LA0240024. The plan is called UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.29% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.71% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 69842LA0240024 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Louisiana | ||||||||||||||||||
| Health Insurance Issuer | UnitedHealthcare Insurance Company | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 69842LA0240024-00 | ||||||||||||||||||
| Provider Network(s) | NON-PREFERRED NETWORK | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Fri, 14 Nov 2025 22:16 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 69842LA0240024-00 Standard On Exchange Plan - 69842LA0240024-01 |
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| Last Plan Update Date | Fri, 16 Aug 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Fri, 14 Nov 2025 22:16 GMT |
Benefits of UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Health Insurance Plan, 69842LA0240024-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan Medically necessary abortions that are required to save the life of the mother are covered. |
NO | ||
| Accidental Dental
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan Benefit limitations may apply to individual services. |
YES | 50.00% |
100.00% |
| Chemotherapy
Exclusions: nan nan |
YES | $750.00 |
100.00% |
| Chiropractic Care
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan Childbirth/delivery professional services follow inpatient physician/surgeon fees. |
YES | $3,000.00 |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months Exclusions: nan nan |
YES | No Charge |
100.00% |
| Diabetes Education
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | $750.00 |
100.00% |
| Durable Medical Equipment
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Emergency Room Services
Exclusions: nan nan |
YES | $2,500.00 |
$2,500.00 |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | $2,500.00 |
$2,500.00 |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Gender Affirming Care
Exclusions: nan Covered when medically necessary. |
YES | $375.00 |
100.00% |
| Generic Drugs
Limit: 30.0 Days per Month Exclusions: nan Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | $25.00 |
100.00% |
| Habilitation Services
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Hearing Aids
Limit: 1.0 Item(s) per 3 Years Exclusions: nan Benefits are limited to one hearing aid, per hearing impaired ear, in a thirty-six (36) month period. |
YES | 50.00% |
100.00% |
| Home Health Care Services
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Hospice Services
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | $200.00 |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | $150.00 |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | $3000.00 Copay per Day |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | $20.00 |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan Benefit limitations may apply to individual services. |
YES | 50.00% |
100.00% |
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | $3000.00 Copay per Day |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan Cost share applies to office visits, please see SBC for Mental Health Outpatient Services. |
YES | $60.00 |
100.00% |
| Non-Preferred Brand Drugs
Limit: 30.0 Days per Month Exclusions: nan Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | 45.00% Coinsurance after deductible |
100.00% |
| Nutritional Counseling
Exclusions: nan Medical or behavioral/mental health related nutritional education services that are provided as part of treatment for a disease are covered |
YES | 50.00% |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan Coverage is for medically necessary orthodontia only. |
YES | 50.00% |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | $375.00 |
100.00% |
| Outpatient Rehabilitation Services
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | $375.00 |
100.00% |
| Preferred Brand Drugs
Limit: 30.0 Days per Month Exclusions: nan Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | 40.00% Coinsurance after deductible |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan Cost sharing for Virtual Primary Care matches in-person office visit. |
YES | $50.00 |
100.00% |
| Private-Duty Nursing
Limit: 19.0 Visit(s) per Year Exclusions: Inpatient Private Duty Nursing Service is not covered. Private Duty Nursing services covered as a part of the Home Health Care benefit. |
YES | 50.00% |
100.00% |
| Prosthetic Devices
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Radiation
Exclusions: nan nan |
YES | $150.00 |
100.00% |
| Reconstructive Surgery
Exclusions: nan Reconstructive procedures are covered when the primary purpose of the procedure is either treatment of a medical condition or required to improve or restore physiologic function. |
YES | $375.00 |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Rehabilitative Speech Therapy
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Visit(s) per Year Exclusions: nan nan |
YES | No Charge |
100.00% |
| Routine Foot Care
Exclusions: nan Covered as medically necessary for the prevention of complications associated with metabolic, neurologic, or peripheral vascular disease |
NO | ||
| Skilled Nursing Facility
Exclusions: nan nan |
YES | $3000.00 Copay per Day |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Specialty Drugs
Limit: 30.0 Days per Month Exclusions: nan Specialty medications are limited to a 1-month supply. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | $3000.00 Copay per Day |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Transplant
Exclusions: nan nan |
YES | $3,000.00 |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
NO | ||
| Urgent Care Centers or Facilities
Exclusions: nan $0 Virtual Urgent Care visits are available through vendor. See SBC for additional cost share details for in-person urgent care visits. |
YES | $100.00 |
100.00% |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | $100.00 |
100.00% |
UHC Bronze-X Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Health Insurance Plan Variant 69842LA0240024-00 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $9000 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $4500 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $4,500 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 1.0 |
| First Tier Utilization | 100% |
| Formulary ID | LAF028 |
| Formulary URL | URL |
| HIOS Product ID | 69842LA024 |
| Import Date | 2024-08-16 01:01:20 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 3 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 64.29% |
| Issuer ID | 69842 |
| Issuer Marketplace Marketing Name | UnitedHealthcare |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | LAN011 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The Network Area may include select Network providers located in a neighboring state. The plan also covers emergency health care services received outside the service area. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 69842LA0240024-00 |
| Plan Level Exclusions | Some exclusions may apply. See the applicable Certificate of Coverage for details. |
| Plan Marketing Name | UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) |
| Plan Type | EPO |
| Plan Variant Marketing Name | UHC Bronze-X Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $3,600 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $700 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $2,600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | LAS011 |
| Source Name | HIOS |
| Specialty Drug Maximum Coinsurance | $150 |
| Plan ID | 69842LA0240024 |
| State Code | LA |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Health Insurance Plan, 69842LA0240024
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals), 69842LA0240024 Health Insurance Plan, 69842LA0240024
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Does UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) Health Insurance Plan, 69842LA0240024 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (69842LA0240024) Health Insurance Plan, Variant (69842LA0240024-00) have Out Of Country Coverage?
Does (69842LA0240024) Health Insurance Plan, Variant (69842LA0240024-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Fri, 14 Nov 2025 22:16 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API