QCA Health Plan, Inc. offers this marketplace health insurance plan (Plan ID 70525AR0210002) 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.
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 Gold 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.
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.
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).
Variant 70525AR0210002-00 (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
$60.00
Tier 1 in-network$60.00
Out-of-network50.00% 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
$60.00
Tier 1 in-network$60.00
Out-of-network50.00% Coinsurance after deductible
Diabetes Education
$60.00
Tier 1 in-network$60.00
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Home Health Care Services
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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
$40.00
Tier 1 in-network$40.00
Out-of-network50.00% 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
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% 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-networkNo Charge
Out-of-network50.00% Coinsurance after deductible
Covered in accordance with ACA guidelines.
Primary Care Visit to Treat an Injury or Illness
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% 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-network50.00% 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-network50.00% 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
$60.00
Tier 1 in-network$60.00
Out-of-network50.00% Coinsurance after deductible
Specialist visits provided to treat a behavioral health diagnosis fall under mental/behavioral health services.
Substance Use Disorder Urgent Care
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% Coinsurance after deductible
Urgent Care Centers or Facilities
$35.00
Tier 1 in-network$35.00
Out-of-network50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
$75.00
Tier 1 in-network$75.00
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Dialysis
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Durable Medical Equipment
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Emergency Room Services
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
Emergency Transportation/Ambulance
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.
Hospice Services
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Inpatient Hospital Services (e.g., Hospital Stay)
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Inpatient Physician and Surgical Services
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Mental/Behavioral Health Emergency Room
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
Mental/Behavioral Health Emergency Transportation/Ambulance
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.
Mental/Behavioral Health Inpatient Services
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Mental/Behavioral Health Outpatient Other Services
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% 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
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% 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)
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% 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-network50.00% 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
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Radiation
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Skilled Nursing Facility
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Substance Abuse Disorder Outpatient Services
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
Substance Use Disorder Emergency Transportation/Ambulance
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.
Substance Use Disorder Outpatient Other Services
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
Substance Use Disorder ER Physician Fee
30.00%
Tier 1 in-network30.00%
Out-of-network30.00%
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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00%
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
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% 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-networkNo Charge
Out-of-networkNo Charge
Limit: 1.0 Exam(s) per Year
Up to $38.50 OON
Well Baby Visits and Care
No Charge
Tier 1 in-networkNo Charge
Out-of-network50.00% Coinsurance after deductible
Pharmacy & drugs
Generic, brand, specialty, and mail order tiers.
Generic Drugs
$3.00
Tier 1 in-network$3.00
Out-of-network100.00%
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
45.00%
Tier 1 in-network45.00%
Out-of-network100.00%
Off Label Prescription Drugs
50.00%
Tier 1 in-network50.00%
Out-of-network100.00%
Preferred Brand Drugs
$50.00
Tier 1 in-network$50.00
Out-of-network100.00%
Preventative Drugs
No Charge
Tier 1 in-networkNo Charge
Out-of-network100.00%
Specialty Drugs
50.00%
Tier 1 in-network50.00%
Out-of-network100.00%
Tier 1b Generic Drugs
$15.00
Tier 1 in-network$15.00
Out-of-network100.00%
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.
Prior authorization may be required - please contact the number listed on your ID card.
Basic Dental Care - Adult
50.00%
Tier 1 in-network50.00%
Out-of-network100.00%
Limit: 1000.0 Dollars per Year
$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults
Dental Anesthesia
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% 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
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% 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-network50.00%
Out-of-network100.00%
Limit: 1000.0 Dollars per Year
$1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults
Nutritional Counseling
$60.00
Tier 1 in-network$60.00
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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-networkNo Charge
Out-of-network100.00%
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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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
$60.00
Tier 1 in-network$60.00
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
Applied Behavior Analysis Based Therapies
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% Coinsurance after deductible
Applied behavior analysis therapies provided to treat a behavioral health diagnosis falls under mental/behavioral health services.
Bariatric Surgery
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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
$40.00
Tier 1 in-network$40.00
Out-of-network50.00% 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-network50.00% Coinsurance after deductible
Limit: 36.0 Visit(s) per Year
Cochlear Implants
30.00%
Tier 1 in-network30.00%
Out-of-network50.00%
Community Health Worke
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Coverage provided for a diagnosis of craniofacial anomaly where surgery and treatment are medically necessary to improve functional impairment.
Doulas
$5.00
Tier 1 in-network$5.00
Out-of-network50.00% 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-networkNo Charge
Out-of-networkNo 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% Coinsurance after deductible
Habilitation Services
$50.00
Tier 1 in-network$50.00
Out-of-network50.00% 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)
$75.00
Tier 1 in-network$75.00
Out-of-network50.00% 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
$40.00
Tier 1 in-network$40.00
Out-of-network50.00% 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
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% 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
30.00%
Tier 1 in-network30.00%
Out-of-network50.00% 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-networkNo Charge
Out-of-network100.00%
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
$60.00
Tier 1 in-network$60.00
Out-of-network50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders
$200.00
Tier 1 in-network$200.00
Out-of-network50.00% Coinsurance after deductible
Prior authorization may be required - please contact the number listed on your ID card.
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.
