Anthem Gold Pathway HMO 3000/20%/6000 - 36239KY1180032 Health Insurance Plan
Anthem Health Plans of Kentucky, Inc. health insurance plan with the Plan ID 36239KY1180032. The plan is called Anthem Gold Pathway HMO 3000/20%/6000.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.62% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.38% 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 79.52% (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 20.48% 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 | 36239KY1180032 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Kentucky | ||||||||||||||||||
| Health Insurance Issuer | Anthem Health Plans of Kentucky, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 36239KY1180032-01 | ||||||||||||||||||
| Provider Network(s) | ['KYN006'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan Variant 36239KY1180032-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.795177481 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 25.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 25.00% |
| Drug EHB Deductible, In Network (Tier 2), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 2), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pregnancy |
| First Tier Utilization | 44% |
| Formulary ID | KYF002 |
| HIOS Product ID | 36239KY118 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 78.62% |
| Issuer ID | 36239 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $3000 per person | $6000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $3,000 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 2), Family | $3000 per person | $6000 per group |
| Medical EHB Deductible, In Network (Tier 2), Individual | $3,000 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Gold |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | KYN006 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 36239KY1180032-01 |
| Plan Marketing Name | Anthem Gold Pathway HMO 3000/20%/6000 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,900 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $3,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,400 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 56% |
| Service Area ID | KYS001 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $600 |
| Plan ID | 36239KY1180032 |
| State Code | KY |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $6000 per person | $12000 per group |
| 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), In Network (Tier 2), Family | $6000 per person | $12000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $6,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Anthem Gold Pathway HMO 3000/20%/6000 Health Insurance Plan, 36239KY1180032
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Anthem Gold Pathway HMO 3000/20%/6000, 36239KY1180032 Health Insurance Plan, 36239KY1180032
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Does Anthem Gold Pathway HMO 3000/20%/6000 Health Insurance Plan, 36239KY1180032 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (36239KY1180032) Health Insurance Plan, Variant (36239KY1180032-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does (36239KY1180032) Health Insurance Plan, Variant (36239KY1180032-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (36239KY1180032) Health Insurance Plan, Variant (36239KY1180032-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan).
Does (36239KY1180032) Health Insurance Plan, Variant (36239KY1180032-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan, Variant (36239KY1180032-01) offer Disease Management Programs for Asthma?
Yes, the Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan Variant
36239KY1180032-01 offers Disease
Management Program for Asthma.
Does Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan, Variant (36239KY1180032-01) offer Disease Management Programs for Heart disease?
Yes, the Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan Variant
36239KY1180032-01 offers Disease
Management Program for Heart disease.
Does Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan, Variant (36239KY1180032-01) offer Disease Management Programs for Depression?
Yes, the Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan Variant
36239KY1180032-01 offers Disease
Management Program for Depression.
Does Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan, Variant (36239KY1180032-01) offer Disease Management Programs for Diabetes?
Yes, the Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan Variant
36239KY1180032-01 offers Disease
Management Program for Diabetes.
Does Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan, Variant (36239KY1180032-01) offer Disease Management Programs for Pregnancy?
Yes, the Anthem Gold Pathway HMO 3000/20%/6000 (SHOP) Health Insurance Plan Variant
36239KY1180032-01 offers Disease
Management Program for Pregnancy.
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