BlueChoice Advantage Gold 1000 - 28137MD0430004 Health Insurance Plan
CareFirst BlueChoice, Inc. health insurance plan with the Plan ID 28137MD0430004. The plan is called BlueChoice Advantage Gold 1000.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.99% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.01% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 28137MD0430004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Maryland | ||||||||||||||||||
| Health Insurance Issuer | CareFirst BlueChoice, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 28137MD0430004-01 | ||||||||||||||||||
| Provider Network(s) | ['MDN006'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
BlueChoice Advantage Gold 1000 Health Insurance Plan Variant 28137MD0430004-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group 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 | $250 per person | per group not applicable |
| Drug EHB Deductible, In Network (Tier 1), Individual | $250 |
| Drug EHB Deductible, Out of Network, Family | $250 per person | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | $250 |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol |
| First Tier Utilization | 100% |
| Formulary ID | MDF009 |
| HIOS Product ID | 28137MD043 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 81.99% |
| Issuer ID | 28137 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $1000 per person | $2000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $1,000 |
| Medical EHB Deductible, Out of Network, Family | $2000 per person | $4000 per group |
| Medical EHB Deductible, Out of Network, Individual | $2,000 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | MDN006 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | All Services |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | All Services |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 28137MD0430004-01 |
| Plan Marketing Name | BlueChoice Advantage Gold 1000 |
| Plan Type | POS |
| Plan Variant Marketing Name | BlueChoice Advantage Gold 1000 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $930 |
| SBC Scenario, Having a Baby, Deductible | $1,000 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $308 |
| SBC Scenario, Having Diabetes, Copayment | $1,035 |
| SBC Scenario, Having Diabetes, Deductible | $1,000 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $63 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $210 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,000 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MDS002 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $150 |
| Plan ID | 28137MD0430004 |
| State Code | MD |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | per person not applicable | per group 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 | $7300 per person | $14600 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,300 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $14600 per person | $29200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $14,600 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of BlueChoice Advantage Gold 1000 Health Insurance Plan, 28137MD0430004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about BlueChoice Advantage Gold 1000, 28137MD0430004 Health Insurance Plan, 28137MD0430004
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Does BlueChoice Advantage Gold 1000 Health Insurance Plan, 28137MD0430004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (28137MD0430004) Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol
Does (28137MD0430004) Health Insurance Plan, Variant (28137MD0430004-01) have Out Of Country Coverage?
Yes. Details: All Services
Does (28137MD0430004) Health Insurance Plan, Variant (28137MD0430004-01) have Out of Service Area Coverage?
Yes. Details: All Services
Does (28137MD0430004) Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol
Does BlueChoice Advantage Gold 1000 Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs for Asthma?
Yes, the BlueChoice Advantage Gold 1000 Health Insurance Plan Variant
28137MD0430004-01 offers Disease
Management Program for Asthma.
Does BlueChoice Advantage Gold 1000 Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs for Heart disease?
Yes, the BlueChoice Advantage Gold 1000 Health Insurance Plan Variant
28137MD0430004-01 offers Disease
Management Program for Heart disease.
Does BlueChoice Advantage Gold 1000 Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs for Depression?
Yes, the BlueChoice Advantage Gold 1000 Health Insurance Plan Variant
28137MD0430004-01 offers Disease
Management Program for Depression.
Does BlueChoice Advantage Gold 1000 Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs for Diabetes?
Yes, the BlueChoice Advantage Gold 1000 Health Insurance Plan Variant
28137MD0430004-01 offers Disease
Management Program for Diabetes.
Does BlueChoice Advantage Gold 1000 Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the BlueChoice Advantage Gold 1000 Health Insurance Plan Variant
28137MD0430004-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does BlueChoice Advantage Gold 1000 Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs for Low back pain?
Yes, the BlueChoice Advantage Gold 1000 Health Insurance Plan Variant
28137MD0430004-01 offers Disease
Management Program for Low back pain.
Does BlueChoice Advantage Gold 1000 Health Insurance Plan, Variant (28137MD0430004-01) offer Disease Management Programs for Pregnancy?
Yes, the BlueChoice Advantage Gold 1000 Health Insurance Plan Variant
28137MD0430004-01 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