Bronze Elite- Specialist Saver - 98517PA0010012 Health Insurance Plan
Oscar Health Plan of Pennsylvania, Inc. health insurance plan with the Plan ID 98517PA0010012. The plan is called Bronze Elite- Specialist Saver.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.74% (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 35.26% 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 | 98517PA0010012 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | Oscar Health Plan of Pennsylvania, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 98517PA0010012-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN001'] | ||||||||||||||||||
| 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 On Exchange Plan - 98517PA0010012-01 |
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| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 98517PA0010012-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.647390302 |
| Business Year | 2023 |
| 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 | 50.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $8000 per person | $16000 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $8,000 |
| Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Drug EHB Deductible, In Network (Tier 2), Family | $8000 per person | $16000 per group |
| Drug EHB Deductible, In Network (Tier 2), Individual | $8,000 |
| 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 | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 20% |
| Formulary ID | PAF001 |
| HIOS Product ID | 98517PA001 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 98517 |
| 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 | $100 per person | $200 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $100 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 2), Family | $100 per person | $200 per group |
| Medical EHB Deductible, In Network (Tier 2), Individual | $100 |
| 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 | Yes |
| National Network | No |
| Network ID | PAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency and Urgent Services Only |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 98517PA0010012-01 |
| Plan Marketing Name | Bronze Elite- Specialist Saver |
| Plan Type | HMO |
| Plan Variant Marketing Name | Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $4,100 |
| SBC Scenario, Having a Baby, Deductible | $100 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $4,200 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $2,100 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 80% |
| Service Area ID | PAS001 |
| Source Name | SERFF |
| Plan ID | 98517PA0010012 |
| State Code | PA |
| 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 | $9100 per person | $18200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family | $9100 per person | $18200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $9,100 |
| 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 | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Bronze Elite- Specialist Saver Health Insurance Plan, 98517PA0010012
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Bronze Elite- Specialist Saver, 98517PA0010012 Health Insurance Plan, 98517PA0010012
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Does Bronze Elite- Specialist Saver Health Insurance Plan, 98517PA0010012 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (98517PA0010012) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does (98517PA0010012) Health Insurance Plan, Variant (98517PA0010012-01) have Out Of Country Coverage?
Yes. Details: Emergency Services Only
Does (98517PA0010012) Health Insurance Plan, Variant (98517PA0010012-01) have Out of Service Area Coverage?
Yes. Details: Emergency and Urgent Services Only
Does (98517PA0010012) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for Asthma?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for Asthma.
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for Heart disease?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for Heart disease.
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for Depression?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for Depression.
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for Diabetes?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for Diabetes.
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for Low back pain?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for Low back pain.
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for Pregnancy?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for Pregnancy.
Does Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (98517PA0010012-01) offer Disease Management Programs for Weight loss programs?
Yes, the Bronze Elite- Specialist Saver ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant
98517PA0010012-01 offers Disease
Management Program for Weight loss programs.
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