Arkansas health plan · 2026

Connected Silver (QualChoice) + Vision + Adult Dental · 70525AR0210001

QCA Health Plan, Inc. offers this marketplace health insurance plan (Plan ID 70525AR0210001) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: POS CSR: Standard Silver Off Exchange Plan Issuer: QCA Health Plan, Inc.
Telehealth Data pending HSA eligible No Dental Adult Vision Adult/Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 71.56%. Expect to pay roughly 28.44% of covered costs out of pocket, based on issuer reporting.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$509 – $1998

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$9,100

$18200 per group

Review MOOP rules

Office visits

Primary care $55.00
Specialist $75.00
HSA Not eligible

Drug tiers

Generic $15.00
Preferred brand $50.00

View formulary tiers

$698 / mo before subsidies

≈ $8374 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$2211 / mo before subsidies

≈ $26538 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2678 / mo before subsidies

≈ $32139 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1702 / mo before subsidies

≈ $20425 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$250.00 Copay after deductible

Durable Medical Equipment

$50.00

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Arkansas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Silver Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$250.00 Copay after deductible

Durable Medical Equipment

$50.00

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 70525AR0210001
Coverage year 2026
State Arkansas
Issuer QCA Health Plan, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 70525AR0210001-00
Available variants

Standard Off Exchange Plan · 70525AR0210001-00

Standard On Exchange Plan · 70525AR0210001-01

Open to Indians below 300% FPL · 70525AR0210001-02

Open to Indians above 300% FPL · 70525AR0210001-03

73% AV Silver Plan · 70525AR0210001-04

87% AV Silver Plan · 70525AR0210001-05

94% AV Silver Plan · 70525AR0210001-06
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Arkansas 2992
PCPs in Arkansas 386
Telehealth support Data pending
Nationwide providers 29761
2,992 doctors statewide 386 PCPs 12 OB/GYN

Provider network(s)

Providers Arkansas All US states
All 2992 29761
PCP 386 3877
Allergy 2 23
OB/GYN 12 126
Dentists 75 1503

Drug coverage overview

4,297 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,493
NON-PREFERREDGENERIC-NON-PREFERREDBRAND 1,804
Prior authorization Drugs
Required 969
Not Required 3,328
Step therapy Drugs
Required 74
Not Required 4,223
Quantity limits Drugs
Has Limit 1,968
No Limit 2,329

Customer highlights

What stands out for members

  • Issuer: QCA Health Plan, Inc. · Plan ID 70525AR0210001 · 2026 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 70525AR0210001-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$75.00
Tier 1 in-network $75.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Diabetes Care Management

$75.00
Tier 1 in-network $75.00
Out-of-network 60.00% Coinsurance after deductible

Diabetes Education

$75.00
Tier 1 in-network $75.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Home Health Care Services

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 50.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card.

Laboratory Outpatient and Professional Services

$60.00
Tier 1 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Laboratory services provided to treat a behavioral health diagnosis fall under mental/behavioral health services. Coverage includes medically necessary biomarker testing.

Mental/Behavioral Health Urgent Care

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Other Practitioner Office Visit (Nurse, Physician Assistant)

$55.00
Tier 1 in-network $55.00
Out-of-network 60.00% Coinsurance after deductible

Benefits include covered services rendered by a certified community health worker within their scope of certification.

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Covered in accordance with ACA guidelines.

Primary Care Visit to Treat an Injury or Illness

$55.00
Tier 1 in-network $55.00
Out-of-network 60.00% Coinsurance after deductible

Primary care visits provided to treat a behavioral health diagnosis fall under mental/behavioral health services.

Rehabilitative Occupational and Rehabilitative Physical Therapy

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

60 inpatient days/year. Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Rehabilitative Speech Therapy

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Specialist Visit

$75.00
Tier 1 in-network $75.00
Out-of-network 60.00% Coinsurance after deductible

Specialist visits provided to treat a behavioral health diagnosis fall under mental/behavioral health services.

Substance Use Disorder Urgent Care

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Urgent Care Centers or Facilities

$60.00
Tier 1 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

X-rays and Diagnostic Imaging

$60.00
Tier 1 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Delivery and All Inpatient Services for Maternity Care

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Dialysis

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Durable Medical Equipment

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Emergency Room Services

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network $250.00 Copay after deductible

Emergency Transportation/Ambulance

$750.00 Copay after deductible
Tier 1 in-network $750.00 Copay after deductible
Out-of-network $750.00 Copay after deductible

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Hospice Services

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Inpatient Hospital Services (e.g., Hospital Stay)

$1000.00 Copay per Day after deductible
Tier 1 in-network $1000.00 Copay per Day after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Inpatient Physician and Surgical Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental/Behavioral Health Emergency Room

$125.00 Copay after deductible
Tier 1 in-network $125.00 Copay after deductible
Out-of-network $125.00 Copay after deductible

Mental/Behavioral Health Emergency Transportation/Ambulance

$125.00 Copay after deductible
Tier 1 in-network $125.00 Copay after deductible
Out-of-network $125.00 Copay after deductible

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Mental/Behavioral Health Inpatient Services

$1000.00 Copay per Day after deductible
Tier 1 in-network $1000.00 Copay per Day after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental/Behavioral Health Outpatient Other Services

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Note: Cost share will be waived for Behavioral Health screening services.

Mental/Behavioral Health Outpatient Services

$55.00
Tier 1 in-network $55.00
Out-of-network 60.00% Coinsurance after deductible

Cost sharing shown applies to outpatient office visits only. See Summary of Benefits and Coverage and the policy for more information on an additional outpatient category, Other Outpatient Services, which may apply a different cost share amount and require prior authorization. Note: Office visits do not require prior authorization. Cost share will be waived for Behavioral Health screening services.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Outpatient Rehabilitation Services

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Outpatient Surgery Physician/Surgical Services

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Radiation

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Skilled Nursing Facility

$100.00 Copay per Day after deductible
Tier 1 in-network $100.00 Copay per Day after deductible
Out-of-network 60.00% Coinsurance after deductible

Limit: 60.0 Days per Year

Prior authorization may be required - please contact the number listed on your ID card.

Substance Abuse Disorder Inpatient Services

$1000.00 Copay per Day after deductible
Tier 1 in-network $1000.00 Copay per Day after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Substance Abuse Disorder Outpatient Services

$55.00
Tier 1 in-network $55.00
Out-of-network 60.00% Coinsurance after deductible

Cost sharing shown applies to outpatient office visits only. See Summary of Benefits and Coverage and the policy for more information on an additional outpatient category, Other Outpatient Services, which may apply a different cost share amount and require prior authorization. Note: Office visits do not require prior authorization. Cost share will be waived for Behavioral Health screening services.

Substance Use Disorder Emergency Room

$125.00 Copay after deductible
Tier 1 in-network $125.00 Copay after deductible
Out-of-network $125.00 Copay after deductible

Substance Use Disorder Emergency Transportation/Ambulance

$125.00 Copay after deductible
Tier 1 in-network $125.00 Copay after deductible
Out-of-network $125.00 Copay after deductible

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Substance Use Disorder Outpatient Other Services

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Note: Cost share will be waived for Behavioral Health screening services.

Transplant

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental health & substance use

Behavioral health visits and substance use treatment.

Mental/Behavioral Health ER Physician Fee

$125.00 Copay after deductible
Tier 1 in-network $125.00 Copay after deductible
Out-of-network $125.00 Copay after deductible

Substance Use Disorder ER Physician Fee

$125.00 Copay after deductible
Tier 1 in-network $125.00 Copay after deductible
Out-of-network $125.00 Copay after deductible

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00%

Limit: 2.0 Item(s) per 3 Years

Prior authorization may be required - please contact the number listed on your ID card.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

$55.00
Tier 1 in-network $55.00
Out-of-network 60.00% Coinsurance after deductible

Coverage includes services rendered by a certified community based doula within the scope of their certification.

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1.0 Exam(s) per Year

Up to $38.50 OON

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Cost sharing shown applies to Tier 1a-Preferred Generic Drugs only. See Summary of Benefits and the policy or service agreement for more information on an additional category, Tier 1b-Generic Drugs, which may apply a higher cost share. Up to a 30 day supply at any participating pharmacy or up to a 90 day supply at a 90 day retail pharmacy. Refer to the prescription drug list for more information.

Non-Preferred Brand Drugs

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 100.00%

Off Label Prescription Drugs

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 100.00%

Preferred Brand Drugs

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Preventative Drugs

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Specialty Drugs

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 100.00%

Tier 1b Generic Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Up to a 30-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy. Refer to the prescription drug list for more information.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Basic Dental Care - Adult

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 1000.0 Dollars per Year

$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

Dental Anesthesia

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Coverage includes IVG treatment for PANS/PANDA diagnosis.

Major Dental Care - Adult

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Limit: 1000.0 Dollars per Year

$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

Nutritional Counseling

$75.00
Tier 1 in-network $75.00
Out-of-network 60.00% Coinsurance after deductible

Nutritional counseling provided to treat a behavioral health diagnosis falls under mental/behavioral health services.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Routine Dental Services (Adult)

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1000.0 Dollars per Year

$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Treatment

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for the medically necessary treatment of severy obesity including bariatric surgery, preoperative, and postoperative care.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acquired Brain Injury

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for medically necessary treatments related to an aquired brain injury. See EOC for a list of covered services.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

$75.00
Tier 1 in-network $75.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Applied Behavior Analysis Based Therapies

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Applied behavior analysis therapies provided to treat a behavioral health diagnosis falls under mental/behavioral health services.

Bariatric Surgery

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for medically necessary expenses for the treatment of diseases and conditions caused by severe obesity, including preoperative and postoperative care. Prior authorization may be required - please contact the number listed on your ID card.

Biomarkers

$60.00
Tier 1 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for medically necessary genetic/molecular cancer biomarker testing.

Cardiac Rehabilitation

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 36.0 Visit(s) per Year

Cochlear Implants

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00%

Community Health Worke

$55.00
Tier 1 in-network $55.00
Out-of-network 60.00% Coinsurance after deductible

Covered services must be rendered by a certified community health worker performing services within their scope of certification.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Craniofacial Surgery

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for a diagnosis of craniofacial anomaly where surgery and treatment are medically necessary to improve functional impairment.

Doulas

$55.00
Tier 1 in-network $55.00
Out-of-network 60.00% Coinsurance after deductible

Coverage includes services rendered by a certified community based doula within the scope of their certification.

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1.0 Item(s) per Year

OON: Up to $50 for frames, $37.50 for lenses and $91 for contacts in lieu of eyeglasses. See EOC for lens limits.

Gastric Electrical Stimulation

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Habilitation Services

$50.00
Tier 1 in-network $50.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient habilitation services; limited to 180 visits per year for developmental services. Habilitation services provided to treat a behavioral health diagnosis fall under mental/behavioral health services. Limits do not apply to mental/behavioral health services.

Imaging (CT/PET Scans, MRIs)

$150.00
Tier 1 in-network $150.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Inherited Metabolic Disorder - PKU

$60.00
Tier 1 in-network $60.00
Out-of-network 60.00% Coinsurance after deductible

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

PANS-PANDA

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for off-label use of intravenous immunoglobulin for the diagnosis of PANS, PANDA, or both.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

1. Treatment provided for the correction of defects incurred in an Accidental Injury sustained by the Member; 2. Surgery performed on a child for the correction of a cleft palate or cleft lip, removal of a port-wine stain or hemangioma (only on the face), or correction of a congenital abnormality; 3. Treatment provided when it is incidental to disease or for reconstructive surgery following neoplastic (cancer) surgery; 4. In connection with a mastectomy resulting from cancer surgery, services for (a) reconstruction of the breast on which the cancer-related surgery was performed; (b) surgery to reconstruct the other breast to produce a symmetrical appearance; and (c) prostheses and services to correct physical complications for all stages of the mastectomy, including lymphedemas; 5. Reduction mammoplasty, if such reduction mammoplasty meets Coverage Criteria. Prior Authorization may be required - please contact the number listed on your ID card.

Routine Eye Exam (Adult)

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

OON exam: Up to $38.50. Benefit also includes 1 pair of eye glasses or contacts per year, covered up to $130 In-Network for frames or $130 In-Network for contacts in lieu of eyeglasses. OON eyewear benefit: covered up to $50 for frames, lenses up to $37.50 and contact lenses up to $91.

Routine Foot Care

$75.00
Tier 1 in-network $75.00
Out-of-network 60.00% Coinsurance after deductible

Treatment for Temporomandibular Joint Disorders

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Well Child Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Variant attributes

Connected Silver (QualChoice) + Vision + Adult Dental · Variant 70525AR0210001-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

70525AR021

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

70525AR0210001-00

Plan Marketing Name

Connected Silver (QualChoice) + Vision + Adult Dental

Plan Variant Marketing Name

Connected Silver (QualChoice) + Vision + Adult Dental

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

71.56%

Issuer ID

70525

Issuer Marketplace Marketing Name

Ambetter from Arkansas Health & Wellness

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

ARN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

ARS001

State Code

AR

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$1,700

SBC Scenario, Having a Baby, Deductible

$7,350

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$2,000

SBC Scenario, Having Diabetes, Deductible

$0

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

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$68200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$34100 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$34,100

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$18200 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$9100 per person

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 Per Group

$50000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$25000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$25,000

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ARF002

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

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), Family Per Group

$2000 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$1000 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$1,000

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, Pregnancy

EHB Percent of Total Premium

0.9721

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

New

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

$44700 per group

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

$22350 per person

Medical EHB Deductible, Combined In/Out of Network, Individual

$22,350

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$14700 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$7350 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$7,350

Medical EHB Deductible, Out of Network, Family Per Group

$30000 per group

Medical EHB Deductible, Out of Network, Family Per Person

$15000 per person

Medical EHB Deductible, Out of Network, Individual

$15,000

Plan Effective Date

1/1/2026

Plan Type

POS

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

70525AR0210001

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Arkansas?

Connected Silver (QualChoice) + Vision + Adult Dental (70525AR0210001) is a Silver POS from QCA Health Plan, Inc. in Arkansas for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Connected Silver (QualChoice) + Vision + Adult Dental support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Connected Silver (QualChoice) + Vision + Adult Dental HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Adult.

Vision add-ons: Adult, Child.

Does Connected Silver (QualChoice) + Vision + Adult Dental support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Connected Silver (QualChoice) + Vision + Adult Dental?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, Pregnancy.

Is there out-of-country coverage for Connected Silver (QualChoice) + Vision + Adult Dental?

No, out-of-country services are not covered for this plan.

Does Connected Silver (QualChoice) + Vision + Adult Dental cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

How do I enroll in or manage payments for Connected Silver (QualChoice) + Vision + Adult Dental?

Use the issuer portal https://www.ambetterhealth.com/en/ar/payments to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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