BlueCare Platinum 24K01-04 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) - 30252FL0140004 Health Insurance Plan

Health Options, Inc. health insurance plan with the Plan ID 30252FL0140004. The plan is called BlueCare Platinum 24K01-04 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 88.44% (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 11.56% 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 30252FL0140004
Health Insurance Plan Year 2025
State Florida
Health Insurance Issuer Health Options, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 30252FL0140004-03
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 Florida All US States
All 67143 124627
PCP 13204 14383
Allergy 43 51
OB/GYN 837 951
Dentists 179 265
Available Variants of the Health Plan

Standard Off Exchange Plan - 30252FL0140004-00

Standard On Exchange Plan - 30252FL0140004-01

Open to Indians below 300% FPL - 30252FL0140004-02

Open to Indians above 300% FPL - 30252FL0140004-03

Last Plan Update Date Thu, 19 Sep 2024 00:00 GMT
Last Import Date Tue, 13 May 2025 06:05 GMT

BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan Variant 30252FL0140004-03 Attributes

Plan Attribute Value
AV Calculator Output Number 0.8844175947435279
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 Limited Cost Sharing Plan Variation
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 10.00%
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 10.00%
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 per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 0%
Formulary ID FLF003
Formulary URL URL
HIOS Product ID 30252FL014
Import Date 2024-09-19 01:01:32
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 30252
Issuer Marketplace Marketing Name Florida Blue HMO (a BlueCross BlueShield FL company)
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 10.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $2000 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $1000 per person
Medical EHB Deductible, In Network (Tier 1), Individual $1,000
Medical EHB Deductible, In Network (Tier 2), Default Coinsurance 10.00%
Medical EHB Deductible, In Network (Tier 2), Family Per Group $2000 per group
Medical EHB Deductible, In Network (Tier 2), Family Per Person $1000 per person
Medical EHB Deductible, In Network (Tier 2), Individual $1,000
Medical EHB Deductible, Out of Network, Family Per Group $4000 per group
Medical EHB Deductible, Out of Network, Family Per Person $2000 per person
Medical EHB Deductible, Out of Network, Individual $2,000
Metal Level Platinum
Multiple In Network Tiers Yes
National Network No
Network ID FLN001
Out of Country Coverage Yes
Out of Country Coverage Description Accident and emergency services.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Accident and emergency services.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 30252FL0140004-03
Plan Marketing Name BlueCare Platinum 24K01-04 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards)
Plan Type POS
Plan Variant Marketing Name BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $600
SBC Scenario, Having a Baby, Copayment $50
SBC Scenario, Having a Baby, Deductible $1,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,500
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $20
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,000
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 100%
Service Area ID FLS001
Source Name HIOS
Plan ID 30252FL0140004
State Code FL
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 $8000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $4000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $4,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group $8000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person $4000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $4,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $8000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $8,000
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of BlueCare Platinum 24K01-04 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, 30252FL0140004

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

Frequently Asked Questions(FAQ) about BlueCare Platinum 24K01-04 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards), 30252FL0140004 Health Insurance Plan, 30252FL0140004

  • Does BlueCare Platinum 24K01-04 ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, 30252FL0140004 support Mail Ordering?

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

  • Does (30252FL0140004) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy

    Does (30252FL0140004) Health Insurance Plan, Variant (30252FL0140004-03) have Out Of Country Coverage?

    Yes. Details: Accident and emergency services.

    Does (30252FL0140004) Health Insurance Plan, Variant (30252FL0140004-03) have Out of Service Area Coverage?

    Yes. Details: Accident and emergency services.

    Does (30252FL0140004) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy

    Does BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs for Asthma?

    Yes, the BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan Variant 30252FL0140004-03 offers Disease Management Program for Asthma.

    Does BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs for Heart disease?

    Yes, the BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan Variant 30252FL0140004-03 offers Disease Management Program for Heart disease.

    Does BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs for Depression?

    Yes, the BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan Variant 30252FL0140004-03 offers Disease Management Program for Depression.

    Does BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs for Diabetes?

    Yes, the BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan Variant 30252FL0140004-03 offers Disease Management Program for Diabetes.

    Does BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan Variant 30252FL0140004-03 offers Disease Management Program for High blood pressure & high cholesterol.

    Does BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan, Variant (30252FL0140004-03) offer Disease Management Programs for Pregnancy?

    Yes, the BlueCare Platinum 24K01-04O ($0 Virtual PCP Visits / $0 Labs / $15 PCP Visits / Rewards) Health Insurance Plan Variant 30252FL0140004-03 offers Disease Management Program for Pregnancy.

 

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