Blue Advantage Silver HMO℠ 205 - 33602TX0460694 Health Insurance Plan

Blue Cross Blue Shield of Texas health insurance plan with the Plan ID 33602TX0460694. The plan is called Blue Advantage Silver HMO℠ 205.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 94.31% (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 5.69% 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 33602TX0460694
Health Insurance Plan Year 2022
State Texas
Health Insurance Issuer Blue Cross Blue Shield of Texas
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 33602TX0460694-06
Provider Network(s) ['TXN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 22 Oct 2024 06:47 GMT).

Providers Texas All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 33602TX0460694-00

Standard On Exchange Plan - 33602TX0460694-01

Open to Indians below 300% FPL - 33602TX0460694-02

Open to Indians above 300% FPL - 33602TX0460694-03

73% AV Silver Plan - 33602TX0460694-04

87% AV Silver Plan - 33602TX0460694-05

94% AV Silver Plan - 33602TX0460694-06

Last Plan Update Date Sat, 06 Nov 2021 00:00 GMT
Last Import Date Tue, 22 Oct 2024 06:47 GMT

Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 Attributes

Plan Attribute Value
AV Calculator Output Number 0.94307044
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 94% AV Level Silver Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 85%
Formulary ID TXF017
Formulary URL URL
HIOS Product ID 33602TX046
Import Date 11/6/2021 0:05
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer ID 33602
Issuer Marketplace Marketing Name Blue Cross and Blue Shield of Texas
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 TXN001
Out of Country Coverage Yes
Out of Country Coverage Description No coverage for any services, supplies or drugs received by a Member outside of the United States, except for Emergency Care
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Coverage outside our service area is available for Emergency and Urgent Care services only.
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 33602TX0460694-06
Plan Marketing Name Blue Advantage Silver HMO℠ 205
Plan Type HMO
Plan Variant Marketing Name Blue Advantage Silver HMO℠ 205
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $900
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $900
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $500
SBC Scenario, Treatment of a Simple Fracture, Copayment $400
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 15%
Service Area ID TXS161
Source Name HIOS
Specialist Requiring a Referral Referrals are required for some services. Please check with your Medical Group for details.
Plan ID 33602TX0460694
State Code TX
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 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $0
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 $2700 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $900 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $900
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group $2700 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person $900 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $900
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 No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Blue Advantage Silver HMO℠ 205 Health Insurance Plan, 33602TX0460694

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Blue Advantage Silver HMO℠ 205, 33602TX0460694 Health Insurance Plan, 33602TX0460694

  • Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, 33602TX0460694 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (33602TX0460694) Health Insurance Plan, Variant (33602TX0460694-06) 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, Pregnancy

    Does (33602TX0460694) Health Insurance Plan, Variant (33602TX0460694-06) have Out Of Country Coverage?

    Yes. Details: No coverage for any services, supplies or drugs received by a Member outside of the United States, except for Emergency Care

    Does (33602TX0460694) Health Insurance Plan, Variant (33602TX0460694-06) have Out of Service Area Coverage?

    Yes. Details: Coverage outside our service area is available for Emergency and Urgent Care services only.

    Does (33602TX0460694) Health Insurance Plan, Variant (33602TX0460694-06) 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, Pregnancy

    Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, Variant (33602TX0460694-06) offer Disease Management Programs for Asthma?

    Yes, the Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 offers Disease Management Program for Asthma.

    Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, Variant (33602TX0460694-06) offer Disease Management Programs for Heart disease?

    Yes, the Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 offers Disease Management Program for Heart disease.

    Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, Variant (33602TX0460694-06) offer Disease Management Programs for Depression?

    Yes, the Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 offers Disease Management Program for Depression.

    Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, Variant (33602TX0460694-06) offer Disease Management Programs for Diabetes?

    Yes, the Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 offers Disease Management Program for Diabetes.

    Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, Variant (33602TX0460694-06) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, Variant (33602TX0460694-06) offer Disease Management Programs for Low back pain?

    Yes, the Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 offers Disease Management Program for Low back pain.

    Does Blue Advantage Silver HMO℠ 205 Health Insurance Plan, Variant (33602TX0460694-06) offer Disease Management Programs for Pregnancy?

    Yes, the Blue Advantage Silver HMO℠ 205 Health Insurance Plan Variant 33602TX0460694-06 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 22 Oct 2024 06:47 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