AmBetter Arizona

Plan Overviews

Ambetter purchased Healthnet in 2016 in Arizona for individual and family healthcare coverage in Arizona that provides affordable options in almost every county. The parent company, Managed Health Services (MHS) has been providing quality medical coverage to Hoosier residents for 21 years. Marketplace policies can easily be purchased, and rates are often lower than other major carriers, such as UnitedHealthcare and Anthem Blue Cross and Blue Shield.

About The Parent Company Centene

Centene is a managed care provider that helps operate the Children’s Health Insurance Program (CHIP), Hoosier Healthwise, and Healthy Arizona. In addition to enrollment duties, they coordinate community events and provide public information about existing and future programs. The National Committee For Quality Assurance (NCQA) has awarded its “commendable” designation to MHS for outstanding services.

MHS is actually a wholly-owned subsidiary of Centene Corporation, which is a Fortune 500 company specializing in providing services to government-funded programs for consumers that are without medical coverage. Some of these programs include Medicaid, Aged, Blind, or Disabled (ABD), and CHIP. Other specialties include managed vision, in-home treatment, special-needs coverage through Medicare, and prescription benefits management.

Plan Name	Secure Care 1 with 3 Free PCP Visits – Standard	Balanced Care 1	Balanced Care 2	Balanced Care 4	Balanced Care 10	Balanced Care 12	Essential Care 1
Medical (Ind/Fam)	$1,000/$2,000	$5,500/$11,000	$6,500/$13,000	$7,050/$14,100	$4,500/$9,000	$3,500/$7,000	$6,800/$13,600
Prescription Drug (Ind/Fam)	$500/$1,000	Integrated with medical ded.	Integrated with medical ded.	Integrated with medical ded.	Integrated with medical ded.	Integrated with medical ded.	Integrated with medical ded.
Metal Level	Gold	Silver	Silver	Silver	Silver	Silver	Bronze
(Ind/Fam)	$6,350/$12,700	$6,500/$13,000	$6,500/$13,000	$7,050/$14,100	$6,500/$13,000	$7,150/$14,300	$6,800/$13,600
Annual Well Visit/ Preventive Care	No charge	No charge	No charge	No charge	No charge	No charge	No charge
PCP Office Visit	20% after ded.	$30	$30	$30	$20	$30	No charge after ded.
Specialist Office Visit	20% after ded.	$60	$60	$60	$40	$65	No charge after ded.
Imaging(CT/PET Scans, MRIs)	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
X-rays & Diagnostic Imaging	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Urgent Care	20% after ded.	$100	$100	$100	$100	$75	No charge after ded.
Emergency Room*	$250 after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	$400 after ded.	No charge after ded.
Emergency Transportation*	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Inpatient Facility Fee	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Inpatient Hospital Physician & Surgical Services	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Outpatient Facility Fee	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Outpatient Surgery Physician/Surgical Services	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Labs & Diagnostics	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Mental/Behavioral Health & Substance Use Disorder Outpatient Services	20% after ded.	$30	$30	$30	$20	$30	No charge after ded.
Rehabilitation Outpatient Services (Includes Speech, Occupational, Physical Therapy)	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Skilled Nursing Facility	20% after ded.	20% after ded.	No charge after ded.	No charge after ded.	20% after ded.	20% after ded.	No charge after ded.
Pediatric Vision – Routine Eye Exam (1 visit per year)	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered
Pediatric Vision- Eyeglasses (frames, 1 per year)	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered
Pediatric Vision- Lenses (per pair)	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered	100% Covered
Pharmacy* (Generic / Preferred / Non-preferred / Specialty)	$10 / $25 after Rx ded. / $75 after Rx ded. / 30% after Rx ded.	$10 / $50 / 20% after Rx ded. / 20% after Rx ded.	$15 / $50 / No charge after ded. / No charge after ded.	$15 / $50 / No charge after ded. / No charge after ded.	$10 / $50 / 20% after ded. / 20% after ded.	$15 / $50 / $100 / 40%	$20 / No charge after ded. / No charge after ded. / No charge after ded

Adult Vision Coverage
(Ages 19 years of age and older*)	Your Cost (In-Network Providers only)	Out-of-network	Subject to Deductible
Routine Eye Exam (1 visit per year)	100% covered	Not Covered	No
Eyeglasses (frames, 1 item per year)	Covered up to $130	Not Covered	No
Lenses (per pair):
Single	100% covered	Not Covered	No
Bifocal	100% covered	Not Covered	No
Trifocal	100% covered	Not Covered	No
Lenticular	100% covered	Not Covered	No
Contact Lenses:
Contact lenses (in lieu of glasses)	Covered up to $130	Not Covered	No
Contact lens fitting	100% covered	Not Covered	No
Specialty lens fitting	Covered up to $50	Not Covered	No

Adult Dental Benefits
(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 (Class 1)	Your Cost (In-Network Providers only)	Out-of-network	Subject to Deductible
Routine Oral Exam (1 per 6 months)	No charge, subject to Annual Maximum	Not Covered	No
Routine Cleaning (1 per 6 months)	No charge, subject to Annual Maximum	Not Covered	No
Bite-wing X-ray (1 per 12 months)	No charge, subject to Annual Maximum	Not Covered	No
Full Mouth X-ray (1 per 60 months)	No charge, subject to Annual Maximum	Not Covered	No
Panoramic Film (1 per 60 months)	No charge, subject to Annual Maximum	Not Covered	No
Topical Fluoride Application (2 per 12 months)	No charge, subject to Annual Maximum	Not Covered	No
Palliative Treatment for relief of pain (minor procedures)	No charge, subject to Annual Maximum	Not Covered	No
Basic Dental (Class 2)	Your Cost (In-Network Providers only)	Out-of-network	Subject to Deductible
Silver Fillings (1 per 2 years)	50% coinsurance, subject to Annual Maximum	Not Covered	No
Tooth Colored Fillings (1 per 2 years, front teeth only)	50% coinsurance, subject to Annual Maximum	Not Covered	No
Therapeutic Pulpotomy on permanent teeth (1 per lifetime per tooth)	50% coinsurance, subject to Annual Maximum	Not Covered	No
Scaling & Root Planning (1 per 24 months)	50% coinsurance, subject to Annual Maximum	Not Covered	No
Periodontal Maintenance (4 in 12 months)	50% coinsurance, subject to Annual Maximum	Not Covered	No
Simple Extractions	50% coinsurance, subject to Annual Maximum	Not Covered	No
Surgical Extractions	50% coinsurance, subject to Annual Maximum	Not Covered	No
Removal of Impacted Teeth	50% coinsurance, subject to Annual Maximum	Not Covered	No
Alveoloplasty	50% coinsurance, subject to Annual Maximum	Not Covered	No
Relines (1 per 36 months)	50% coinsurance, subject to Annual Maximum	Not Covered	No
Rebase (1 per 36 months)	50% coinsurance, subject to Annual Maximum	Not Covered	No
Adjustments	50% coinsurance, subject to Annual Maximum	Not Covered	No
Repairs	50% coinsurance, subject to Annual Maximum	Not Covered	No

*If you require coverage for Pediatric Dental please shop on the Health Insurance Marketplace for a stand alone dental plan.

**Dental Annual Maximum Benefit does not apply toward any other maximums.

Ambetter Hospital Network

With offices in Scottsdale, Tempe, and Tuscon, Ambetter offers low-cost healthcare throughout much of the state.

Network Providers

The network provider list is quite extensive, and includes primary care physicians, specialists, Urgent-Care locations, hospitals, and many other medical and rehabilitation and treatment facilities. For example, if you lived in the Scottsdale area, the following hospitals would be considered “in-network.” We used a 40-mile radius.

Hospital Name	Specialties	Address	Accepting New Patients	In Network
Scottsdale Healthcare Osborn	General Acute Care Hospital	7400 East Osborn Rd, Scottsdale, AZ, 85251	Yes	Yes
Banner Thunderbird Medical	General Acute Care Hospital	5555 W Thunderbird Road, Phoenix, AZ, 85080	Yes	Yes
Tempe St Lukes Medical Center	General Acute Care Hospital	1500 South Mill Avenue, Tempe, AZ, 85281	Yes	Yes
Scottsdale Healthcare Shea	General Acute Care Hospital	9003 East Shea Boulevard, Floor 1, Scottsdale, AZ, 85260	Yes	Yes
Scottsdale Healthcare Hospitals	General Acute Care Hospital	250 East Dunlap Avenue, Phoenix, AZ, 85020	Yes	Yes
Scottsdale Healthcare Hospitals	General Acute Care Hospital	250 East Dunlap Avenue, Phoenix, AZ, 85020	Yes	Yes
Valleywise Health	General Acute Care Hospital	570 West Brown Road, Mesa, AZ, 85201	Yes	Yes
Valleywise Health	General Acute Care Hospital	2601 E Roosevelt Street, Phoenix, AZ, 85008	Yes	Yes

Valleywise Health	General Acute Care Hospital	2525 East Roosevelt Street, Phoenix, AZ, 85008	Yes	Yes
Valleywise Health	General Acute Care Hospital	2619 East Pierce Street, Phoenix, AZ, 85008	Yes	Yes
OASIS Hospital	Special Hospital	750 North 40th Street, Phoenix, AZ, 85008	Yes	Yes
Banner Desert Medical Center	General Acute Care Hospital	1400 South Dobson Road, Mesa, AZ, 85202	Yes	Yes
Banner Good Samaritan Med Centertx	General Acute Care Hospital	1111 East McDowell Road, Phoenix, AZ, 85006	Yes	Yes
Valleywise Health	General Acute Care Hospital	2525 E Roosevelt Street, Phoenix, AZ, 85008	Yes	Yes
Abrazo Arizona Heart Hospital	General Acute Care Hospital	1930 East Thomas Road, Phoenix, AZ, 85016	Yes	Yes
Kpc Promise Hospital Of Phoenix Llc	Long Term Care Hospital	433 East 6th Street, Mesa, AZ, 85203	Yes	Yes
Select Specialty Hosp Px Downtown	Long Term Care Hospital	1111 East McDowell Road, 11th Floor, Phoenix, AZ, 85006	Yes	Yes
Select Specialty Hospital-Scottsdale	Long Term Care Hospital	1012 E Willetta Street, 4th Floor, Phoenix, AZ, 85006	Yes	Yes
BHSM Rehabilitation	Rehabilitation Hospital	775 East Willetta Street, Phoenix, AZ, 85006	Yes	Yes
Select Specialty Hospital Phoenix	Long Term Care Hospital	350 West Thomas Road, 3rd Floor, Phoenix, AZ, 85013	Yes	Yes
Encompass Health Rehabilitation Institute of Tucson	Rehabilitation Hospital	9630 East Shea Boulevard, Scottsdale, AZ, 85260	Yes	YeWhat About Doctors?

The availability of primary care physicians (PCP) allows you to choose from many doctors within your area. Specialists, behavioral health, dental and vision options are also plentiful. We listed below the number of network PCPs in several large and small cities. After each city, shown is the number of providers within a 20-mile radius. Typically, the number of available providers increases each year. NOTE: A 24/7 nurse advice line is also available. Registered and licensed nurses can provide professional assistance to current policyholders.

Cochise
Coconino
Gila
Graham
Greenlee
Maricopa
Pima
Pinal
Santa Cruz

NOTE: You can also search for your Ambetter provider here.

When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services.

A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later.

If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance.

So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.

My Health Pays Reward Program

As an Ambetter member, you can earn reward dollars for taking charge of your health. Their My Health Pays™ program rewards you for completing healthy activities.

You will receive your My Health Pays™ Visa® Prepaid Card when you earn your first reward. If you already have a My Health Pays™ Visa Prepaid Card, your reward dollars will be added to your existing card. They’ll automatically add any new rewards you earn to your My Health Pays™ Visa Prepaid Card. The more you do, the more reward dollars will be added to your card. It’s that simple!

Start Earning My Health Pays™ rewards today!

Sample image of the My Health Pays Visa card

YOU CAN USE YOUR REWARDS TO HELP PAY
FOR YOUR HEALTHCARE COSTS, SUCH AS:

Your monthly premium payments

Doctor copays*

Deductibles

Coinsurance

*My Health Pays™ rewards cannot be used for pharmacy copays.

HERE IS HOW YOU CAN EARN MY HEALTH PAYS™ REWARDS:

Earn $50

Complete your Ambetter Wellbeing Survey during the first 90 days of your membership and earn $50 in rewards. Start the survey now!

Earn $50

Get your annual wellness exam with your primary care provider (PCP). Find a PCP.

Earn $25

Receive your annual flu vaccine in the fall (9/1-12/31) and earn $25 in rewards. Schedule it with your PCP.

Earn up to $20 a month!

Visit any gym at least eight times in a month and earn up to $20 in rewards. To find a gym near you, visit globalfit.com

Log in to your secure online member account to track your rewards, view your card balance and complete healthy activities, such as your Wellbeing Survey.

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Ambetter Arizona

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(312) 726-6565

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