CareSource Marketplace Gold Dental, Vision, & Fitness - 45636KY0020015 Health Insurance Plan
CareSource Kentucky Co. health insurance plan with the Plan ID 45636KY0020015. The plan is called CareSource Marketplace Gold Dental, Vision, & Fitness.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 79.64% (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 20.36% 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 | 45636KY0020015 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Kentucky | ||||||||||||||||||
| Health Insurance Issuer | CareSource Kentucky Co. | ||||||||||||||||||
| Health Insurance Plan Variant | 45636KY0020015-01 | ||||||||||||||||||
| Provider Network(s) | ['KYN001'] | ||||||||||||||||||
| 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 - 45636KY0020015-01 |
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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 |
CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant 45636KY0020015-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.796383397 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 98.68% |
| First Tier Utilization | 100% |
| Formulary ID | KYF003 |
| HIOS Product ID | 45636KY002 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 45636 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | KYN001 |
| 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 Services Only |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 45636KY0020015-01 |
| Plan Marketing Name | CareSource Marketplace Gold Dental, Vision, & Fitness |
| Plan Type | HMO |
| Plan Variant Marketing Name | CareSource Marketplace Gold Dental, Vision, & Fitness |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,700 |
| SBC Scenario, Having a Baby, Copayment | $500 |
| SBC Scenario, Having a Baby, Deductible | $2,000 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $500 |
| SBC Scenario, Having Diabetes, Copayment | $500 |
| SBC Scenario, Having Diabetes, Deductible | $2,000 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,000 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | KYS001 |
| Source Name | SERFF |
| Plan ID | 45636KY0020015 |
| State Code | KY |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | $7000 per person | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $7,000 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | $2000 per person | $4000 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $2,000 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 25.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $2000 per person | $4000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| 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 | $7000 per person | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,000 |
| 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 | Yes |
Copay & Coinsurance of CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, 45636KY0020015
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about CareSource Marketplace Gold Dental, Vision, & Fitness, 45636KY0020015 Health Insurance Plan, 45636KY0020015
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Does CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, 45636KY0020015 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (45636KY0020015) Health Insurance Plan, Variant (45636KY0020015-01) 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 (45636KY0020015) Health Insurance Plan, Variant (45636KY0020015-01) have Out Of Country Coverage?
Yes. Details: Emergency Services Only
Does (45636KY0020015) Health Insurance Plan, Variant (45636KY0020015-01) have Out of Service Area Coverage?
Yes. Details: Emergency Services Only
Does (45636KY0020015) Health Insurance Plan, Variant (45636KY0020015-01) 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 CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, Variant (45636KY0020015-01) offer Disease Management Programs for Asthma?
Yes, the CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant
45636KY0020015-01 offers Disease
Management Program for Asthma.
Does CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, Variant (45636KY0020015-01) offer Disease Management Programs for Heart disease?
Yes, the CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant
45636KY0020015-01 offers Disease
Management Program for Heart disease.
Does CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, Variant (45636KY0020015-01) offer Disease Management Programs for Depression?
Yes, the CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant
45636KY0020015-01 offers Disease
Management Program for Depression.
Does CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, Variant (45636KY0020015-01) offer Disease Management Programs for Diabetes?
Yes, the CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant
45636KY0020015-01 offers Disease
Management Program for Diabetes.
Does CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, Variant (45636KY0020015-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant
45636KY0020015-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, Variant (45636KY0020015-01) offer Disease Management Programs for Low back pain?
Yes, the CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant
45636KY0020015-01 offers Disease
Management Program for Low back pain.
Does CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan, Variant (45636KY0020015-01) offer Disease Management Programs for Pregnancy?
Yes, the CareSource Marketplace Gold Dental, Vision, & Fitness Health Insurance Plan Variant
45636KY0020015-01 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