2022 POS 2500 Elite Gold - 20129IL0340070 Health Insurance Plan
Health Alliance Medical Plans, Inc. health insurance plan with the Plan ID 20129IL0340070. The plan is called 2022 POS 2500 Elite Gold.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 80.86% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 19.14% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
| Health Insurance Plan ID | 20129IL0340070 | ||||||||||||||||||
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| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Illinois | ||||||||||||||||||
| Health Insurance Issuer | Health Alliance Medical Plans, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 20129IL0340070-00 | ||||||||||||||||||
| Provider Network(s) | ['ILN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 20129IL0340070-00 Standard On Exchange Plan - 20129IL0340070-01 |
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| Last Plan Update Date | Wed, 01 Dec 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 30 Apr 2024 06:06 GMT |
2022 POS 2500 Elite Gold Health Insurance Plan Variant 20129IL0340070-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.808587791 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2022 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold 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 | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| EHB Percent of Total Premium | 0.996 |
| First Tier Utilization | 100% |
| Formulary ID | ILF002 |
| Formulary URL | URL |
| HIOS Product ID | 20129IL034 |
| Import Date | 12/1/2021 20:01 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 20129 |
| Issuer Marketplace Marketing Name | Health Alliance |
| 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 | $15000 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $7500 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $7,500 |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 15.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $5000 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $2500 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $2,500 |
| Medical EHB Deductible, Out of Network, Family Per Group | $10000 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $5000 per person |
| Medical EHB Deductible, Out of Network, Individual | $5,000 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ILN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Out of Network Coverage Available |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of Network Coverage Available |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan ID (Standard Component ID with Variant) | 20129IL0340070-00 |
| Plan Level Exclusions | Custodial Care, Weight Lost Programs |
| Plan Marketing Name | 2022 POS 2500 Elite Gold |
| Plan Type | POS |
| Plan Variant Marketing Name | 2022 POS 2500 Elite Gold |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,400 |
| SBC Scenario, Having a Baby, Copayment | $200 |
| SBC Scenario, Having a Baby, Deductible | $2,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $800 |
| SBC Scenario, Having Diabetes, Deductible | $1,100 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $10 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ILS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Specialists (IN) may require a referral except OB-GYN and Optometrists |
| Plan ID | 20129IL0340070 |
| State Code | IL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $47000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $23500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $23,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $12000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $6000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $6,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $35000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $17500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $17,500 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of 2022 POS 2500 Elite Gold Health Insurance Plan, 20129IL0340070
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about 2022 POS 2500 Elite Gold, 20129IL0340070 Health Insurance Plan, 20129IL0340070
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Does 2022 POS 2500 Elite Gold Health Insurance Plan, 20129IL0340070 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (20129IL0340070) Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does (20129IL0340070) Health Insurance Plan, Variant (20129IL0340070-00) have Out Of Country Coverage?
Yes. Details: Out of Network Coverage Available
Does (20129IL0340070) Health Insurance Plan, Variant (20129IL0340070-00) have Out of Service Area Coverage?
Yes. Details: Out of Network Coverage Available
Does (20129IL0340070) Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for Asthma?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for Asthma.
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for Heart disease?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for Heart disease.
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for Depression?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for Depression.
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for Diabetes?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for Diabetes.
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for Low back pain?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for Low back pain.
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for Pregnancy?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for Pregnancy.
Does 2022 POS 2500 Elite Gold Health Insurance Plan, Variant (20129IL0340070-00) offer Disease Management Programs for Weight loss programs?
Yes, the 2022 POS 2500 Elite Gold Health Insurance Plan Variant
20129IL0340070-00 offers Disease
Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Tue, 30 Apr 2024 06:06 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