Complete HMO 30/55 - 41304MA0041890 Health Insurance Plan
AllWays Health Partners health insurance plan with the Plan ID 41304MA0041890. The plan is called Complete HMO 30/55.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.97% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.03% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 41304MA0041890 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Massachusetts | ||||||||||||||||||
| Health Insurance Issuer | AllWays Health Partners | ||||||||||||||||||
| Health Insurance Plan Variant | 41304MA0041890-01 | ||||||||||||||||||
| Provider Network(s) | ['MAN001'] | ||||||||||||||||||
| 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, 22 May 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Standard High Gold: Complete HMO 30/55 Health Insurance Plan Variant 41304MA0041890-01 Attributes
| Plan Attribute | Value |
|---|---|
| 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 |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs |
| First Tier Utilization | 100% |
| Formulary ID | MAF002 |
| HIOS Product ID | 41304MA004 |
| HSA/HRA Employer Contribution | No |
| Import Date | 5/22/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 81.97% |
| Issuer ID | 41304 |
| Market Coverage | SHOP (Small Group) |
| 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 | MAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Urgent and Emergency only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Urgent and Emergency only |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 41304MA0041890-01 |
| Plan Marketing Name | Complete HMO 30/55 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Standard High Gold: Complete HMO 30/55 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,100 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,000 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $60 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $700 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MAS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All except: Gynecologist or Obstetrician for routine, preventive or urgent care; Family Planning services; Outpatient and Diversionary Behavioral Health Services; Routine Eye Exam; Physical Therapy; Occupational Therapy; Speech Therapy and Emergency Services. |
| Plan ID | 41304MA0041890 |
| State Code | MA |
| 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 | $5000 per person | $10000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $5,000 |
| 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 | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Complete HMO 30/55 Health Insurance Plan, 41304MA0041890
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Complete HMO 30/55, 41304MA0041890 Health Insurance Plan, 41304MA0041890
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Does Complete HMO 30/55 Health Insurance Plan, 41304MA0041890 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (41304MA0041890) Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs
Does (41304MA0041890) Health Insurance Plan, Variant (41304MA0041890-01) have Out Of Country Coverage?
Yes. Details: Urgent and Emergency only
Does (41304MA0041890) Health Insurance Plan, Variant (41304MA0041890-01) have Out of Service Area Coverage?
Yes. Details: Urgent and Emergency only
Does (41304MA0041890) Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs
Does Standard High Gold: Complete HMO 30/55 Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs for Asthma?
Yes, the Standard High Gold: Complete HMO 30/55 Health Insurance Plan Variant
41304MA0041890-01 offers Disease
Management Program for Asthma.
Does Standard High Gold: Complete HMO 30/55 Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs for Heart disease?
Yes, the Standard High Gold: Complete HMO 30/55 Health Insurance Plan Variant
41304MA0041890-01 offers Disease
Management Program for Heart disease.
Does Standard High Gold: Complete HMO 30/55 Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs for Depression?
Yes, the Standard High Gold: Complete HMO 30/55 Health Insurance Plan Variant
41304MA0041890-01 offers Disease
Management Program for Depression.
Does Standard High Gold: Complete HMO 30/55 Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs for Diabetes?
Yes, the Standard High Gold: Complete HMO 30/55 Health Insurance Plan Variant
41304MA0041890-01 offers Disease
Management Program for Diabetes.
Does Standard High Gold: Complete HMO 30/55 Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs for Pregnancy?
Yes, the Standard High Gold: Complete HMO 30/55 Health Insurance Plan Variant
41304MA0041890-01 offers Disease
Management Program for Pregnancy.
Does Standard High Gold: Complete HMO 30/55 Health Insurance Plan, Variant (41304MA0041890-01) offer Disease Management Programs for Weight loss programs?
Yes, the Standard High Gold: Complete HMO 30/55 Health Insurance Plan Variant
41304MA0041890-01 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