Blue Cross® Premier PPO Bronze Saver - 15560MI0350005 Health Insurance Plan

Blue Cross Blue Shield of Michigan Mutual Insurance Company health insurance plan with the Plan ID 15560MI0350005. The plan is called Blue Cross® Premier PPO Bronze Saver.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 61.06% (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 38.94% 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 15560MI0350005
Health Insurance Plan Year 2022
State Michigan
Health Insurance Issuer Blue Cross Blue Shield of Michigan Mutual Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 15560MI0350005-03
Provider Network(s) ['MIN006']
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 Michigan 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 - 15560MI0350005-00

Standard On Exchange Plan - 15560MI0350005-01

Open to Indians below 300% FPL - 15560MI0350005-02

Open to Indians above 300% FPL - 15560MI0350005-03

Last Plan Update Date Wed, 18 Aug 2021 00:00 GMT
Last Import Date Tue, 22 Oct 2024 06:47 GMT

Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 Attributes

Plan Attribute Value
AV Calculator Output Number 0.610579081
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 Limited Cost Sharing Plan Variation
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID MIF051
Formulary URL URL
HIOS Product ID 15560MI035
Import Date 8/18/2021 20:00
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 15560
Issuer Marketplace Marketing Name Blue Cross Blue Shield of Michigan Mutual Insurance Company
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Bronze
Multiple In Network Tiers No
National Network Yes
Network ID MIN006
Out of Country Coverage Yes
Out of Country Coverage Description Accidental injury and emergency only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Coverage outside the state of Michigan is out of network except for eligible urgent, emergency and accidental injuries services
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 15560MI0350005-03
Plan Marketing Name Blue Cross® Premier PPO Bronze Saver
Plan Type PPO
Plan Variant Marketing Name Blue Cross® Premier PPO Bronze Saver
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $8,700
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,400
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
Service Area ID MIS001
Source Name SERFF
Plan ID 15560MI0350005
State Code MI
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 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $17400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $8700 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $8,700
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $34800 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $17400 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $17,400
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $34800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $17400 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $17,400
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, 15560MI0350005

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

Frequently Asked Questions(FAQ) about Blue Cross® Premier PPO Bronze Saver, 15560MI0350005 Health Insurance Plan, 15560MI0350005

  • Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, 15560MI0350005 support Mail Ordering?

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

  • Does (15560MI0350005) Health Insurance Plan, Variant (15560MI0350005-03) 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, Weight Loss Programs

    Does (15560MI0350005) Health Insurance Plan, Variant (15560MI0350005-03) have Out Of Country Coverage?

    Yes. Details: Accidental injury and emergency only

    Does (15560MI0350005) Health Insurance Plan, Variant (15560MI0350005-03) have Out of Service Area Coverage?

    Yes. Details: Coverage outside the state of Michigan is out of network except for eligible urgent, emergency and accidental injuries services

    Does (15560MI0350005) Health Insurance Plan, Variant (15560MI0350005-03) 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, Weight Loss Programs

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for Asthma?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for Asthma.

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for Heart disease?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for Heart disease.

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for Depression?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for Depression.

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for Diabetes?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for Diabetes.

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for Low back pain?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for Low back pain.

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for Pregnancy?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for Pregnancy.

    Does Blue Cross® Premier PPO Bronze Saver Health Insurance Plan, Variant (15560MI0350005-03) offer Disease Management Programs for Weight loss programs?

    Yes, the Blue Cross® Premier PPO Bronze Saver Health Insurance Plan Variant 15560MI0350005-03 offers Disease Management Program for Weight loss programs.

 

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