Bronze $0 Medical Deductible - 39889UT0010016 Health Insurance Plan
Bright HealthCare health insurance plan with the Plan ID 39889UT0010016. The plan is called Bronze $0 Medical Deductible .
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.98% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.02% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.70% (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 35.30% 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 | 39889UT0010016 | ||||||||||||||||||
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| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Utah | ||||||||||||||||||
| Health Insurance Issuer | Bright HealthCare | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 39889UT0010016-00 | ||||||||||||||||||
| Provider Network(s) | ['UTN001'] | ||||||||||||||||||
| 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 - 39889UT0010016-00 Standard On Exchange Plan - 39889UT0010016-01 |
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| Last Plan Update Date | Fri, 11 Feb 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Bronze $0 Medical Deductible Direct Health Insurance Plan Variant 39889UT0010016-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.647009356 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 1 |
| 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 Bronze 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 | 50.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $9900 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $4950 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $4,950 |
| 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 |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 100% |
| Formulary ID | UTF009 |
| Formulary URL | URL |
| HIOS Product ID | 39889UT001 |
| Import Date | 2/11/2022 20:01 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 2 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 64.98% |
| Issuer ID | 39889 |
| Issuer Marketplace Marketing Name | Bright HealthCare |
| 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 | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | UTN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan ID (Standard Component ID with Variant) | 39889UT0010016-00 |
| Plan Marketing Name | Bronze $0 Medical Deductible |
| Plan Type | EPO |
| Plan Variant Marketing Name | Bronze $0 Medical Deductible Direct |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $6,700 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $400 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $3,100 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $800 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $1,100 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | UTS001 |
| Source Name | SERFF |
| Plan ID | 39889UT0010016 |
| State Code | UT |
| 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 | $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 | 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 Bronze $0 Medical Deductible Health Insurance Plan, 39889UT0010016
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Bronze $0 Medical Deductible , 39889UT0010016 Health Insurance Plan, 39889UT0010016
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Does Bronze $0 Medical Deductible Health Insurance Plan, 39889UT0010016 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (39889UT0010016) Health Insurance Plan, Variant (39889UT0010016-00) 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, Pregnancy
Does (39889UT0010016) Health Insurance Plan, Variant (39889UT0010016-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (39889UT0010016) Health Insurance Plan, Variant (39889UT0010016-00) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan).
Does (39889UT0010016) Health Insurance Plan, Variant (39889UT0010016-00) 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, Pregnancy
Does Bronze $0 Medical Deductible Direct Health Insurance Plan, Variant (39889UT0010016-00) offer Disease Management Programs for Asthma?
Yes, the Bronze $0 Medical Deductible Direct Health Insurance Plan Variant
39889UT0010016-00 offers Disease
Management Program for Asthma.
Does Bronze $0 Medical Deductible Direct Health Insurance Plan, Variant (39889UT0010016-00) offer Disease Management Programs for Heart disease?
Yes, the Bronze $0 Medical Deductible Direct Health Insurance Plan Variant
39889UT0010016-00 offers Disease
Management Program for Heart disease.
Does Bronze $0 Medical Deductible Direct Health Insurance Plan, Variant (39889UT0010016-00) offer Disease Management Programs for Depression?
Yes, the Bronze $0 Medical Deductible Direct Health Insurance Plan Variant
39889UT0010016-00 offers Disease
Management Program for Depression.
Does Bronze $0 Medical Deductible Direct Health Insurance Plan, Variant (39889UT0010016-00) offer Disease Management Programs for Diabetes?
Yes, the Bronze $0 Medical Deductible Direct Health Insurance Plan Variant
39889UT0010016-00 offers Disease
Management Program for Diabetes.
Does Bronze $0 Medical Deductible Direct Health Insurance Plan, Variant (39889UT0010016-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Bronze $0 Medical Deductible Direct Health Insurance Plan Variant
39889UT0010016-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Bronze $0 Medical Deductible Direct Health Insurance Plan, Variant (39889UT0010016-00) offer Disease Management Programs for Low back pain?
Yes, the Bronze $0 Medical Deductible Direct Health Insurance Plan Variant
39889UT0010016-00 offers Disease
Management Program for Low back pain.
Does Bronze $0 Medical Deductible Direct Health Insurance Plan, Variant (39889UT0010016-00) offer Disease Management Programs for Pregnancy?
Yes, the Bronze $0 Medical Deductible Direct Health Insurance Plan Variant
39889UT0010016-00 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