Catastrophic PPO 9100/0/0 - 45127PA0020027 Health Insurance Plan
Capital Advantage Assurance Company health insurance plan with the Plan ID 45127PA0020027. The plan is called Catastrophic PPO 9100/0/0.
| Health Insurance Plan ID | 45127PA0020027 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | Capital Advantage Assurance Company | ||||||||||||||||||
| Health Insurance Plan Variant | 45127PA0020027-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN006'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Catastrophic PPO 9100/0/0 Health Insurance Plan Variant 45127PA0020027-01 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 4 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Catastrophic On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pregnancy |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | PAF001 |
| HIOS Product ID | 45127PA002 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 45127 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Catastrophic |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | PAN006 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Out of Country services are covered in accordance with your benefit contract. Certain services may not be covered. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of Service Area services are covered in accordance with your benefit contract. Certain services may not be covered. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 45127PA0020027-01 |
| Plan Marketing Name | Catastrophic PPO 9100/0/0 |
| Plan Type | PPO |
| Plan Variant Marketing Name | Catastrophic PPO 9100/0/0 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,100 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,300 |
| SBC Scenario, Having Diabetes, Limit | $30 |
| 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 | PAS004 |
| Source Name | SERFF |
| Plan ID | 45127PA0020027 |
| 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 |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $9100 per person | $18200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,100 |
| TEHBDedOutofNetFamily | $9100 per person | $18200 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $9,100 |
| 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), Out of Network, Family | $10000 per person | $20000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $10,000 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Catastrophic PPO 9100/0/0 Health Insurance Plan, 45127PA0020027
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Catastrophic PPO 9100/0/0, 45127PA0020027 Health Insurance Plan, 45127PA0020027
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Does Catastrophic PPO 9100/0/0 Health Insurance Plan, 45127PA0020027 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) have Out Of Country Coverage?
Yes. Details: Out of Country services are covered in accordance with your benefit contract. Certain services may not be covered.
Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) have Out of Service Area Coverage?
Yes. Details: Out of Service Area services are covered in accordance with your benefit contract. Certain services may not be covered.
Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does Catastrophic PPO 9100/0/0 Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Asthma?
Yes, the Catastrophic PPO 9100/0/0 Health Insurance Plan Variant
45127PA0020027-01 offers Disease
Management Program for Asthma.
Does Catastrophic PPO 9100/0/0 Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Heart disease?
Yes, the Catastrophic PPO 9100/0/0 Health Insurance Plan Variant
45127PA0020027-01 offers Disease
Management Program for Heart disease.
Does Catastrophic PPO 9100/0/0 Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Depression?
Yes, the Catastrophic PPO 9100/0/0 Health Insurance Plan Variant
45127PA0020027-01 offers Disease
Management Program for Depression.
Does Catastrophic PPO 9100/0/0 Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Diabetes?
Yes, the Catastrophic PPO 9100/0/0 Health Insurance Plan Variant
45127PA0020027-01 offers Disease
Management Program for Diabetes.
Does Catastrophic PPO 9100/0/0 Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Pregnancy?
Yes, the Catastrophic PPO 9100/0/0 Health Insurance Plan Variant
45127PA0020027-01 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