Bronze HSA - 80473WA0780001 Health Insurance Plan

Kaiser Foundation Health Plan of Washington health insurance plan with the Plan ID 80473WA0780001. The plan is called Bronze HSA.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.56% (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 35.44% 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 80473WA0780001
Health Insurance Plan Year 2023
State Washington
Health Insurance Issuer Kaiser Foundation Health Plan of Washington
Health Insurance Plan Variant 80473WA0780001-01
Provider Network(s) ['WAN004']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT).

Providers Washington All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard On Exchange Plan - 80473WA0780001-01

Open to Indians below 300% FPL - 80473WA0780001-02

Open to Indians above 300% FPL - 80473WA0780001-03

Last Plan Update Date Mon, 23 Jan 2023 00:00 GMT
Last Import Date Tue, 07 May 2024 06:08 GMT

Bronze HSA Health Insurance Plan Variant 80473WA0780001-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.645615584
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
EHB Percent of Total Premium 99.23%
First Tier Utilization 100%
Formulary ID WAF003
HIOS Product ID 80473WA078
Import Date 1/23/2023
HSA Eligible Yes
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer ID 80473
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID WAN004
Out of Country Coverage No
Out of Service Area Coverage No
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 80473WA0780001-01
Plan Marketing Name Bronze HSA
Plan Type HMO
Plan Variant Marketing Name Bronze HSA
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $900
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $6,050
SBC Scenario, Having a Baby, Limit $20
SBC Scenario, Having Diabetes, Coinsurance $200
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $4,700
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID WAS003
Source Name SERFF
Specialist Requiring a Referral allergy, audiology, cardiology, chemical dependency, chiropractic/manipulative therapy, dermatology, gastroenterology, general surgery, hospice, mental health, nephrology, neurology, obstetrics and gynecology, occupational medicine, oncology/hematology, ophthalmology, optometry, orthopedics, otolaryngology (ear, nose and throat), physical therapy, smoking cessation, speech/language and learning services and urology
Plan ID 80473WA0780001
State Code WA
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
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family per person not applicable | per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $6050 per person | $12100 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,050
TEHBDedOutofNetFamily per person not applicable | per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $6900 per person | $13800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,900
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 HSA Health Insurance Plan, 80473WA0780001

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

Frequently Asked Questions(FAQ) about Bronze HSA, 80473WA0780001 Health Insurance Plan, 80473WA0780001

  • Does Bronze HSA Health Insurance Plan, 80473WA0780001 support Mail Ordering?

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

  • Does (80473WA0780001) Health Insurance Plan, Variant (80473WA0780001-01) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (80473WA0780001) Health Insurance Plan, Variant (80473WA0780001-01) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

 

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