Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision - 93187VA0070051 Health Insurance Plan
Aetna Health Inc. (a PA corp.) health insurance plan with the Plan ID 93187VA0070051. The plan is called Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.99% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.01% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 93187VA0070051 | ||||||||||||||||||
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| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Virginia | ||||||||||||||||||
| Health Insurance Issuer | Aetna Health Inc. (a PA corp.) | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 93187VA0070051-01 | ||||||||||||||||||
| Provider Network(s) | PREFERRED NON-PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 21 Oct 2025 05:32 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 93187VA0070051-01 |
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| Last Plan Update Date | Fri, 17 Oct 2025 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 21 Oct 2025 05:32 GMT |
Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant 93187VA0070051-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze 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 | $4995 per person | $9990 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $4,995 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 93% |
| First Tier Utilization | 100% |
| Formulary ID | VAF012 |
| HIOS Product ID | 93187VA007 |
| Import Date | 1/13/2025 |
| Inpatient Copayment Maximum Days | 3 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 64.99% |
| Issuer ID | 93187 |
| 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 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 | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group 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 | VAN004 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | Except for Emergencies |
| Plan Effective Date | 1/1/2025 |
| Plan ID (Standard Component ID with Variant) | 93187VA0070051-01 |
| Plan Marketing Name | Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision |
| Plan Type | HMO |
| Plan Variant Marketing Name | Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $5,400 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $2,900 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $2,000 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | VAS004 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician. |
| Plan ID | 93187VA0070051 |
| State Code | VA |
| 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 | $9195 per person | $18390 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,195 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, 93187VA0070051
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision, 93187VA0070051 Health Insurance Plan, 93187VA0070051
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Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, 93187VA0070051 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (93187VA0070051) Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does (93187VA0070051) Health Insurance Plan, Variant (93187VA0070051-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (93187VA0070051) Health Insurance Plan, Variant (93187VA0070051-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan). Details: Except for Emergencies
Does (93187VA0070051) Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs for Asthma?
Yes, the Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant
93187VA0070051-01 offers Disease
Management Program for Asthma.
Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs for Heart disease?
Yes, the Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant
93187VA0070051-01 offers Disease
Management Program for Heart disease.
Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs for Depression?
Yes, the Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant
93187VA0070051-01 offers Disease
Management Program for Depression.
Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs for Diabetes?
Yes, the Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant
93187VA0070051-01 offers Disease
Management Program for Diabetes.
Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant
93187VA0070051-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs for Low back pain?
Yes, the Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant
93187VA0070051-01 offers Disease
Management Program for Low back pain.
Does Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan, Variant (93187VA0070051-01) offer Disease Management Programs for Pregnancy?
Yes, the Bronze 4 Advanced: HMO Aetna network + Adult Dental + Vision Health Insurance Plan Variant
93187VA0070051-01 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 21 Oct 2025 05:32 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