Access Ind Silver ID - 38128ID0160002 Health Insurance Plan
Mountain Health Cooperative health insurance plan with the Plan ID 38128ID0160002. The plan is called Access Ind Silver ID.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.39% (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 28.61% 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 | 38128ID0160002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | Mountain Health Cooperative | ||||||||||||||||||
| Health Insurance Plan Variant | 38128ID0160002-01 | ||||||||||||||||||
| Provider Network(s) | ['IDN003'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 38128ID0160002-01 Open to Indians below 300% FPL - 38128ID0160002-02 Open to Indians above 300% FPL - 38128ID0160002-03 73% AV Silver Plan - 38128ID0160002-04 |
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| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Access Ind Silver ID Health Insurance Plan Variant 38128ID0160002-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.713923932 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | IDF004 |
| HIOS Product ID | 38128ID016 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 38128 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | IDN003 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergent Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergent Only |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 38128ID0160002-01 |
| Plan Marketing Name | Access Ind Silver ID |
| Plan Type | POS |
| Plan Variant Marketing Name | Access Ind Silver ID |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $3,400 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $4,100 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $300 |
| SBC Scenario, Having Diabetes, Deductible | $4,000 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,700 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | IDS002 |
| Source Name | SERFF |
| Plan ID | 38128ID0160002 |
| State Code | ID |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | $24000 per person | $48000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $24,000 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | $12300 per person | $24600 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $12,300 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $4100 per person | $8200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $4,100 |
| TEHBDedOutofNetFamily | $8200 per person | $16400 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $8,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $8000 per person | $16000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $16000 per person | $32000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $16,000 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Access Ind Silver ID Health Insurance Plan, 38128ID0160002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Access Ind Silver ID, 38128ID0160002 Health Insurance Plan, 38128ID0160002
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Does Access Ind Silver ID Health Insurance Plan, 38128ID0160002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (38128ID0160002) Health Insurance Plan, Variant (38128ID0160002-01) have Out Of Country Coverage?
Does (38128ID0160002) Health Insurance Plan, Variant (38128ID0160002-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 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