Anthem Platinum Preferred Blue PPO 200 20 3225 - 57601NH0350011 Health Insurance Plan
Anthem Health Plans of NH(Anthem BCBS) health insurance plan with the Plan ID 57601NH0350011. The plan is called Anthem Platinum Preferred Blue PPO 200 20 3225.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 86.02% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 13.98% 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 86.25% (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 13.75% 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 | 57601NH0350011 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | New Hampshire | ||||||||||||||||||
| Health Insurance Issuer | Anthem Health Plans of NH(Anthem BCBS) | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 57601NH0350011-00 | ||||||||||||||||||
| Provider Network(s) | ['NHN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 04 Apr 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 30 Apr 2024 06:06 GMT |
Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan Variant 57601NH0350011-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.862466119 |
| 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 Platinum 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 | 40.00% |
| 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, In Network (Tier 2), Default Coinsurance | 40.00% |
| Drug EHB Deductible, In Network (Tier 2), Family Per Group | $0 per group |
| Drug EHB Deductible, In Network (Tier 2), Family Per Person | $0 per person |
| Drug EHB Deductible, In Network (Tier 2), 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, Pregnancy |
| First Tier Utilization | 52% |
| Formulary ID | NHF004 |
| Formulary URL | URL |
| HIOS Product ID | 57601NH035 |
| 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 | 86.02% |
| Issuer ID | 57601 |
| Issuer Marketplace Marketing Name | Anthem Blue Cross and Blue Sheld |
| 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 Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person 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 Per Group | $600 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $200 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $200 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 2), Family Per Group | $600 per group |
| Medical EHB Deductible, In Network (Tier 2), Family Per Person | $200 per person |
| Medical EHB Deductible, In Network (Tier 2), Individual | $200 |
| Medical EHB Deductible, Out of Network, Family Per Group | $4000 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $2000 per person |
| Medical EHB Deductible, Out of Network, Individual | $2,000 |
| Metal Level | Platinum |
| Multiple In Network Tiers | Yes |
| National Network | Yes |
| Network ID | NHN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Full Access |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Standard Bluecard PPO Network |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 57601NH0350011-00 |
| Plan Marketing Name | Anthem Platinum Preferred Blue PPO 200 20 3225 |
| Plan Type | PPO |
| Plan Variant Marketing Name | Anthem Platinum Preferred Blue PPO 200 20 3225 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,200 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $200 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $2,100 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $200 |
| 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 | 57601NH0350011 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $6450 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $3225 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $3,225 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $6450 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $3225 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $3,225 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $12900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $6450 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $6,450 |
| Unique Plan Design | Yes |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan, 57601NH0350011
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Anthem Platinum Preferred Blue PPO 200 20 3225, 57601NH0350011 Health Insurance Plan, 57601NH0350011
-
Does Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan, 57601NH0350011 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (57601NH0350011) Health Insurance Plan, Variant (57601NH0350011-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does (57601NH0350011) Health Insurance Plan, Variant (57601NH0350011-00) have Out Of Country Coverage?
Yes. Details: Full Access
Does (57601NH0350011) Health Insurance Plan, Variant (57601NH0350011-00) have Out of Service Area Coverage?
Yes. Details: Standard Bluecard PPO Network
Does (57601NH0350011) Health Insurance Plan, Variant (57601NH0350011-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan, Variant (57601NH0350011-00) offer Disease Management Programs for Asthma?
Yes, the Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan Variant
57601NH0350011-00 offers Disease
Management Program for Asthma.
Does Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan, Variant (57601NH0350011-00) offer Disease Management Programs for Heart disease?
Yes, the Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan Variant
57601NH0350011-00 offers Disease
Management Program for Heart disease.
Does Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan, Variant (57601NH0350011-00) offer Disease Management Programs for Depression?
Yes, the Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan Variant
57601NH0350011-00 offers Disease
Management Program for Depression.
Does Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan, Variant (57601NH0350011-00) offer Disease Management Programs for Diabetes?
Yes, the Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan Variant
57601NH0350011-00 offers Disease
Management Program for Diabetes.
Does Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan, Variant (57601NH0350011-00) offer Disease Management Programs for Pregnancy?
Yes, the Anthem Platinum Preferred Blue PPO 200 20 3225 Health Insurance Plan Variant
57601NH0350011-00 offers Disease
Management Program for Pregnancy.
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