Blue Congaree Standard Silver - 26065SC0720006 Health Insurance Plan

Blue Cross and Blue Shield of South Carolina health insurance plan with the Plan ID 26065SC0720006. The plan is called Blue Congaree Standard Silver.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 73.09% (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 26.91% 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 26065SC0720006
Health Insurance Plan Year 2025
State South Carolina
Health Insurance Issuer Blue Cross and Blue Shield of South Carolina
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 26065SC0720006-04
Provider Network(s) PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT).

Providers South Carolina All US States
All 21433 27759
PCP 3586 4928
Allergy 10 17
OB/GYN 157 221
Dentists 838 955
Available Variants of the Health Plan

Standard Off Exchange Plan - 26065SC0720006-00

Standard On Exchange Plan - 26065SC0720006-01

Open to Indians below 300% FPL - 26065SC0720006-02

Open to Indians above 300% FPL - 26065SC0720006-03

73% AV Silver Plan - 26065SC0720006-04

87% AV Silver Plan - 26065SC0720006-05

94% AV Silver Plan - 26065SC0720006-06

Last Plan Update Date Wed, 19 Feb 2025 00:00 GMT
Last Import Date Tue, 13 May 2025 06:05 GMT

Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 Attributes

Plan Attribute Value
AV Calculator Output Number 0.7309378231069821
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type 73% AV Level Silver Plan
Dental Only Plan No
Design Type Design 1
Disease Management Programs Offered Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID SCF017
Formulary URL URL
HIOS Product ID 26065SC072
Import Date 2025-02-19 01:01:54
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? No
Issuer ID 26065
Issuer Marketplace Marketing Name BlueCross BlueShield of South Carolina
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID SCN005
Out of Country Coverage No
Out of Country Coverage Description Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.
Out of Service Area Coverage No
Out of Service Area Coverage Description Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 26065SC0720006-04
Plan Marketing Name Blue Congaree Standard Silver
Plan Type HMO
Plan Variant Marketing Name Blue Congaree Standard Silver
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,400
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $3,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $100
SBC Scenario, Having Diabetes, Copayment $900
SBC Scenario, Having Diabetes, Deductible $3,000
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $400
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID SCS004
Source Name HIOS
Plan ID 26065SC0720006
State Code SC
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 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $6000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $3000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $3,000
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 $12800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6400 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,400
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 Yes

Copay & Coinsurance of Blue Congaree Standard Silver Health Insurance Plan, 26065SC0720006

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

Frequently Asked Questions(FAQ) about Blue Congaree Standard Silver, 26065SC0720006 Health Insurance Plan, 26065SC0720006

  • Does Blue Congaree Standard Silver Health Insurance Plan, 26065SC0720006 support Mail Ordering?

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

  • Does (26065SC0720006) Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs

    Does (26065SC0720006) Health Insurance Plan, Variant (26065SC0720006-04) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan). Details: Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.

    Does (26065SC0720006) Health Insurance Plan, Variant (26065SC0720006-04) 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: Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.

    Does (26065SC0720006) Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for Asthma?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for Asthma.

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for Heart disease?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for Heart disease.

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for Depression?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for Depression.

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for Diabetes?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for Diabetes.

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for Low back pain?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for Low back pain.

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for Pregnancy?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for Pregnancy.

    Does Blue Congaree Standard Silver Health Insurance Plan, Variant (26065SC0720006-04) offer Disease Management Programs for Weight loss programs?

    Yes, the Blue Congaree Standard Silver Health Insurance Plan Variant 26065SC0720006-04 offers Disease Management Program for Weight loss programs.

 

Disclaimer: This is based on the import(Date: Tue, 13 May 2025 06:05 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