AmeriHealth Caritas Next

AmeriHealth Caritas Next Bronze Essential + No Referrals

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Plan Overview

Combined Medical and Drug Deductible	Individual: $9,200.00 Family: $18400 Per Person: $9200
Combined Medical and Drug Out of Pocket Maximum	Individual: $9,200.00 Family: $18400 Per Person: $9200

Office Visit

Primary Doctor	CoPay: No Charge after 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. Additional information can be found on the member's schedule of benefits.
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 Exclusions: Excludes injections by a health care professional of injectable which can be self-administered, unless medical supervision is required; drugs associated with conception by artificial means; experimental drugs as outlined in document. 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 Exclusions: Excludes injections by a health care professional of injectable which can be self-administered, unless medical supervision is required; drugs associated with conception by artificial means; experimental drugs as outlined in document. Benefit Explanation: Certain off-label uses of cancer drugs will be covered in accordance with state law.
Generic Drugs	CoPay: No Charge after deductible CoInsurance: Not Applicable Covered: Covered Exclusions: Excludes injections by a health care professional of injectable which can be self-administered, unless medical supervision is required; drugs associated with conception by artificial means; experimental drugs as outlined in document. 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 Exclusions: Excludes injections by a health care professional of injectable which can be self-administered, unless medical supervision is required; drugs associated with conception by artificial means; experimental drugs as outlined in document. 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: No Charge after 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. Additional information can be found on the member's schedule of benefits.

Maternity

Labor and Delivery Hospital Stay

CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Exclusions: Maternity services rendered to a covered person who is acting as a gestational surrogate are excluded and for services related to surrogate parenting
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 after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit : Exam(s) per Benefit Period

Major Dental Care

Routine Dental Checkups for Children	Covered: Not Covered
Routine Dental Checkups for Adults	Covered: Not Covered

AmeriHealth Caritas Next Bronze Essential + No Referrals

Plan Overview

Office Visit

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Maternity

Vision

Major Dental Care

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