Blue Cross Select Gold - 46944AL0650001 Health Insurance Plan
Blue Cross and Blue Shield of Alabama health insurance plan with the Plan ID 46944AL0650001. The plan is called Blue Cross Select Gold.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 79.79% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 20.21% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 46944AL0650001 | ||||||||||||||||||
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| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Alabama | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross and Blue Shield of Alabama | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 46944AL0650001-00 | ||||||||||||||||||
| Provider Network(s) | ['ALN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 46944AL0650001-00 Standard On Exchange Plan - 46944AL0650001-01 |
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| Last Plan Update Date | Sat, 26 Mar 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Blue Cross Select Gold Health Insurance Plan Variant 46944AL0650001-00 Attributes
| Plan Attribute | Value |
|---|---|
| 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 Gold 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 | 0.00% |
| 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 | 0.00% |
| 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 | $0 per group |
| Drug EHB Deductible, Out of Network, Family Per Person | $0 per person |
| Drug EHB Deductible, Out of Network, Individual | $0 |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, Pregnancy |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 98% |
| Formulary ID | ALF201 |
| Formulary URL | URL |
| HIOS Product ID | 46944AL065 |
| Import Date | 3/26/2022 8:21 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 5 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 79.79% |
| Issuer ID | 46944 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Alabama |
| Market Coverage | Individual |
| 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 | $1700 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $850 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $850 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 2), Family Per Group | $1700 per group |
| Medical EHB Deductible, In Network (Tier 2), Family Per Person | $850 per person |
| Medical EHB Deductible, In Network (Tier 2), Individual | $850 |
| Medical EHB Deductible, Out of Network, Family Per Group | $3400 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $1700 per person |
| Medical EHB Deductible, Out of Network, Individual | $1,700 |
| Metal Level | Gold |
| Multiple In Network Tiers | Yes |
| National Network | Yes |
| Network ID | ALN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan ID (Standard Component ID with Variant) | 46944AL0650001-00 |
| Plan Marketing Name | Blue Cross Select Gold |
| Plan Type | PPO |
| Plan Variant Marketing Name | Blue Cross Select Gold |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $600 |
| SBC Scenario, Having a Baby, Deductible | $850 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $200 |
| SBC Scenario, Having Diabetes, Limit | $40 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $850 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 2% |
| Service Area ID | ALS001 |
| Source Name | HIOS |
| Specialist Requiring a Referral | All specialists seen in an office setting, excluding OB/GYN. |
| Plan ID | 46944AL0650001 |
| State Code | AL |
| 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 | $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 | Yes |
Copay & Coinsurance of Blue Cross Select Gold Health Insurance Plan, 46944AL0650001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Blue Cross Select Gold, 46944AL0650001 Health Insurance Plan, 46944AL0650001
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Does Blue Cross Select Gold Health Insurance Plan, 46944AL0650001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (46944AL0650001) Health Insurance Plan, Variant (46944AL0650001-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does (46944AL0650001) Health Insurance Plan, Variant (46944AL0650001-00) have Out Of Country Coverage?
Yes. Details: If PPO provider is used, same benefits as PPO in country apply. If non-PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.
Does (46944AL0650001) Health Insurance Plan, Variant (46944AL0650001-00) have Out of Service Area Coverage?
Yes. Details: If PPO provider is used, same benefits as PPO in service area apply. If non-PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.
Does (46944AL0650001) Health Insurance Plan, Variant (46944AL0650001-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does Blue Cross Select Gold Health Insurance Plan, Variant (46944AL0650001-00) offer Disease Management Programs for Asthma?
Yes, the Blue Cross Select Gold Health Insurance Plan Variant
46944AL0650001-00 offers Disease
Management Program for Asthma.
Does Blue Cross Select Gold Health Insurance Plan, Variant (46944AL0650001-00) offer Disease Management Programs for Heart disease?
Yes, the Blue Cross Select Gold Health Insurance Plan Variant
46944AL0650001-00 offers Disease
Management Program for Heart disease.
Does Blue Cross Select Gold Health Insurance Plan, Variant (46944AL0650001-00) offer Disease Management Programs for Diabetes?
Yes, the Blue Cross Select Gold Health Insurance Plan Variant
46944AL0650001-00 offers Disease
Management Program for Diabetes.
Does Blue Cross Select Gold Health Insurance Plan, Variant (46944AL0650001-00) offer Disease Management Programs for Pregnancy?
Yes, the Blue Cross Select Gold Health Insurance Plan Variant
46944AL0650001-00 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 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