Anthem Bronze Pathway X HMO 8000 50 8700 - 96751NH0160030 Health Insurance Plan
Matthew Thornton Hlth Plan(Anthem BCBS) health insurance plan with the Plan ID 96751NH0160030. The plan is called Anthem Bronze Pathway X HMO 8000 50 8700.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 63.45% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 36.55% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.26% (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 35.74% 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 | 96751NH0160030 | ||||||||||||||||||
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| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | New Hampshire | ||||||||||||||||||
| Health Insurance Issuer | Matthew Thornton Hlth Plan(Anthem BCBS) | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 96751NH0160030-00 | ||||||||||||||||||
| Provider Network(s) | ['NHN003'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 14 May 2024 06:16 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 04 Apr 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 14 May 2024 06:16 GMT |
Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan Variant 96751NH0160030-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.642593962 |
| 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 Bronze Off Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pregnancy |
| First Tier Utilization | 52% |
| Formulary ID | NHF001 |
| Formulary URL | URL |
| HIOS Product ID | 96751NH016 |
| HSA/HRA Employer Contribution | No |
| Import Date | 4/4/2022 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 63.45% |
| Issuer ID | 96751 |
| Issuer Marketplace Marketing Name | Anthem Blue Cross and Blue Shield |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | NHN003 |
| Out of Country Coverage | No |
| Out of Country Coverage Description | Emergency Coverage Only |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | TRAD/PAR network |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 96751NH0160030-00 |
| Plan Marketing Name | Anthem Bronze Pathway X HMO 8000 50 8700 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Anthem Bronze Pathway X HMO 8000 50 8700 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $700 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $800 |
| SBC Scenario, Having Diabetes, Deductible | $4,300 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 48% |
| Service Area ID | NHS002 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $650 |
| Plan ID | 96751NH0160030 |
| State Code | NH |
| 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 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $16000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $8000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,000 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $16000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $8000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $8,000 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $17400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8700 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,700 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $17400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $8700 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $8,700 |
| 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 Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan, 96751NH0160030
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Anthem Bronze Pathway X HMO 8000 50 8700, 96751NH0160030 Health Insurance Plan, 96751NH0160030
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Does Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan, 96751NH0160030 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (96751NH0160030) Health Insurance Plan, Variant (96751NH0160030-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does (96751NH0160030) Health Insurance Plan, Variant (96751NH0160030-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan). Details: Emergency Coverage Only
Does (96751NH0160030) Health Insurance Plan, Variant (96751NH0160030-00) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan). Details: TRAD/PAR network
Does (96751NH0160030) Health Insurance Plan, Variant (96751NH0160030-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan, Variant (96751NH0160030-00) offer Disease Management Programs for Asthma?
Yes, the Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan Variant
96751NH0160030-00 offers Disease
Management Program for Asthma.
Does Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan, Variant (96751NH0160030-00) offer Disease Management Programs for Heart disease?
Yes, the Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan Variant
96751NH0160030-00 offers Disease
Management Program for Heart disease.
Does Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan, Variant (96751NH0160030-00) offer Disease Management Programs for Depression?
Yes, the Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan Variant
96751NH0160030-00 offers Disease
Management Program for Depression.
Does Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan, Variant (96751NH0160030-00) offer Disease Management Programs for Diabetes?
Yes, the Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan Variant
96751NH0160030-00 offers Disease
Management Program for Diabetes.
Does Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan, Variant (96751NH0160030-00) offer Disease Management Programs for Pregnancy?
Yes, the Anthem Bronze Pathway X HMO 8000 50 8700 Health Insurance Plan Variant
96751NH0160030-00 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 14 May 2024 06:16 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