Connect Bronze 2000 Indiv Med Deductible - 53882IL0040009 Health Insurance Plan
Cigna HealthCare of Illinois, Inc. health insurance plan with the Plan ID 53882IL0040009. The plan is called Connect Bronze 2000 Indiv Med Deductible.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.76% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.24% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 67.12% (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 32.88% 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 | 53882IL0040009 | ||||||||||||||||||
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| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Illinois | ||||||||||||||||||
| Health Insurance Issuer | Cigna HealthCare of Illinois, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 53882IL0040009-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Jun 2025 12:51 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 53882IL0040009-00 Standard On Exchange Plan - 53882IL0040009-01 |
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| Last Plan Update Date | Thu, 12 Sep 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 17 Jun 2025 12:51 GMT |
Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan Variant 53882IL0040009-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.6711951742375121 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person 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 Per Group | $10000 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $5000 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $5,000 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy |
| EHB Percent of Total Premium | 0.998 |
| First Tier Utilization | 100% |
| Formulary ID | ILF003 |
| Formulary URL | URL |
| HIOS Product ID | 53882IL004 |
| Import Date | 2024-09-12 20:01:47 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 3 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 64.76% |
| Issuer ID | 53882 |
| Issuer Marketplace Marketing Name | Cigna Healthcare |
| 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 Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person 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 Per Group | $4000 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $2000 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ILN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency Only |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 53882IL0040009-00 |
| Plan Marketing Name | Connect Bronze 2000 Indiv Med Deductible |
| Plan Type | HMO |
| Plan Variant Marketing Name | Connect Bronze 2000 Indiv Med Deductible |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,200 |
| SBC Scenario, Having a Baby, Copayment | $5,600 |
| SBC Scenario, Having a Baby, Deductible | $2,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $800 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,700 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ILS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All Specialist |
| Plan ID | 53882IL0040009 |
| State Code | IL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person 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 Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan, 53882IL0040009
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Connect Bronze 2000 Indiv Med Deductible, 53882IL0040009 Health Insurance Plan, 53882IL0040009
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Does Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan, 53882IL0040009 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (53882IL0040009) Health Insurance Plan, Variant (53882IL0040009-00) offer Disease Management Programs?
Does (53882IL0040009) Health Insurance Plan, Variant (53882IL0040009-00) have Out Of Country Coverage?
Does (53882IL0040009) Health Insurance Plan, Variant (53882IL0040009-00) have Out of Service Area Coverage?
Does (53882IL0040009) Health Insurance Plan, Variant (53882IL0040009-00) offer Disease Management Programs?
Does Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan, Variant (53882IL0040009-00) offer Disease Management Programs for Asthma?
Does Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan, Variant (53882IL0040009-00) offer Disease Management Programs for Heart disease?
Does Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan, Variant (53882IL0040009-00) offer Disease Management Programs for Diabetes?
Does Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan, Variant (53882IL0040009-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Connect Bronze 2000 Indiv Med Deductible Health Insurance Plan, Variant (53882IL0040009-00) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 17 Jun 2025 12:51 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