Anthem Silver Pathway X 2950 for HSA - 32753MO0950007 Health Insurance Plan
Healthy Alliance Life Co(Anthem BCBS) health insurance plan with the Plan ID 32753MO0950007. The plan is called Anthem Silver Pathway X 2950 for HSA.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 69.99% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.01% 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 70.48% (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 29.52% 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 | 32753MO0950007 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Missouri | ||||||||||||||||||
| Health Insurance Issuer | Healthy Alliance Life Co(Anthem BCBS) | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 32753MO0950007-00 | ||||||||||||||||||
| Provider Network(s) | ['MON001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 32753MO0950007-00 Standard On Exchange Plan - 32753MO0950007-01 Open to Indians below 300% FPL - 32753MO0950007-02 Open to Indians above 300% FPL - 32753MO0950007-03 73% AV Silver Plan - 32753MO0950007-04 |
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| Last Plan Update Date | Sat, 14 Aug 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Anthem Silver Pathway 2950 for HSA Health Insurance Plan Variant 32753MO0950007-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.704845709 |
| 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 Silver Off Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 60% |
| Formulary ID | MOF003 |
| Formulary URL | URL |
| HIOS Product ID | 32753MO095 |
| Import Date | 8/14/2021 0:43 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | Yes |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 69.99% |
| Issuer ID | 32753 |
| Issuer Marketplace Marketing Name | Anthem Blue Cross and Blue Shield |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | MON001 |
| Out of Country Coverage | No |
| Out of Country Coverage Description | Urgent/Emergency Coverage Only |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | BlueCard PPO Basic Network |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 32753MO0950007-00 |
| Plan Marketing Name | Anthem Silver Pathway X 2950 for HSA |
| Plan Type | EPO |
| Plan Variant Marketing Name | Anthem Silver Pathway 2950 for HSA |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $3,100 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $2,950 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $500 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $2,950 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 40% |
| Service Area ID | MOS001 |
| Source Name | HIOS |
| Plan ID | 32753MO0950007 |
| State Code | MO |
| 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $5900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $2950 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,950 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $5900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $2950 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $2,950 |
| 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 | $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), In Network (Tier 2), Family Per Group | $12000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $6000 per person |
| 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 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 Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Anthem Silver Pathway X 2950 for HSA Health Insurance Plan, 32753MO0950007
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Anthem Silver Pathway X 2950 for HSA, 32753MO0950007 Health Insurance Plan, 32753MO0950007
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Does Anthem Silver Pathway X 2950 for HSA Health Insurance Plan, 32753MO0950007 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (32753MO0950007) Health Insurance Plan, Variant (32753MO0950007-00) 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
Does (32753MO0950007) Health Insurance Plan, Variant (32753MO0950007-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan). Details: Urgent/Emergency Coverage Only
Does (32753MO0950007) Health Insurance Plan, Variant (32753MO0950007-00) 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: BlueCard PPO Basic Network
Does (32753MO0950007) Health Insurance Plan, Variant (32753MO0950007-00) 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
Does Anthem Silver Pathway 2950 for HSA Health Insurance Plan, Variant (32753MO0950007-00) offer Disease Management Programs for Asthma?
Yes, the Anthem Silver Pathway 2950 for HSA Health Insurance Plan Variant
32753MO0950007-00 offers Disease
Management Program for Asthma.
Does Anthem Silver Pathway 2950 for HSA Health Insurance Plan, Variant (32753MO0950007-00) offer Disease Management Programs for Heart disease?
Yes, the Anthem Silver Pathway 2950 for HSA Health Insurance Plan Variant
32753MO0950007-00 offers Disease
Management Program for Heart disease.
Does Anthem Silver Pathway 2950 for HSA Health Insurance Plan, Variant (32753MO0950007-00) offer Disease Management Programs for Depression?
Yes, the Anthem Silver Pathway 2950 for HSA Health Insurance Plan Variant
32753MO0950007-00 offers Disease
Management Program for Depression.
Does Anthem Silver Pathway 2950 for HSA Health Insurance Plan, Variant (32753MO0950007-00) offer Disease Management Programs for Diabetes?
Yes, the Anthem Silver Pathway 2950 for HSA Health Insurance Plan Variant
32753MO0950007-00 offers Disease
Management Program for Diabetes.
Does Anthem Silver Pathway 2950 for HSA Health Insurance Plan, Variant (32753MO0950007-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Anthem Silver Pathway 2950 for HSA Health Insurance Plan Variant
32753MO0950007-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Anthem Silver Pathway 2950 for HSA Health Insurance Plan, Variant (32753MO0950007-00) offer Disease Management Programs for Low back pain?
Yes, the Anthem Silver Pathway 2950 for HSA Health Insurance Plan Variant
32753MO0950007-00 offers Disease
Management Program for Low back pain.
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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