Engage Ind Bronze ID - 38128ID0140003 Health Insurance Plan
Mountain Health Cooperative health insurance plan with the Plan ID 38128ID0140003. The plan is called Engage Ind Bronze ID.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 62.71% (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 37.29% 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 | 38128ID0140003 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | Mountain Health Cooperative | ||||||||||||||||||
| Health Insurance Plan Variant | 38128ID0140003-01 | ||||||||||||||||||
| Provider Network(s) | ['IDN002'] | ||||||||||||||||||
| 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 | Standard On Exchange Plan - 38128ID0140003-01 |
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| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Engage Ind Bronze ID Health Insurance Plan Variant 38128ID0140003-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.627131815 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 3 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Diabetes |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | IDF001 |
| HIOS Product ID | 38128ID014 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 38128 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | IDN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergent Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergent Only |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 38128ID0140003-01 |
| Plan Marketing Name | Engage Ind Bronze ID |
| Plan Type | POS |
| Plan Variant Marketing Name | Engage Ind Bronze ID |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,550 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,200 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| 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 | $2,400 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | IDS003 |
| Source Name | SERFF |
| Plan ID | 38128ID0140003 |
| State Code | ID |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | $25650 per person | $51300 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $25,650 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | $25650 per person | $51300 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $25,650 |
| 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 | $8550 per person | $17100 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,550 |
| TEHBDedOutofNetFamily | $17100 per person | $34200 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $17,100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $8550 per person | $17100 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,550 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $17100 per person | $34200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $17,100 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Engage Ind Bronze ID Health Insurance Plan, 38128ID0140003
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Engage Ind Bronze ID, 38128ID0140003 Health Insurance Plan, 38128ID0140003
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Does Engage Ind Bronze ID Health Insurance Plan, 38128ID0140003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (38128ID0140003) Health Insurance Plan, Variant (38128ID0140003-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes
Does (38128ID0140003) Health Insurance Plan, Variant (38128ID0140003-01) have Out Of Country Coverage?
Yes. Details: Emergent Only
Does (38128ID0140003) Health Insurance Plan, Variant (38128ID0140003-01) have Out of Service Area Coverage?
Yes. Details: Emergent Only
Does (38128ID0140003) Health Insurance Plan, Variant (38128ID0140003-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes
Does Engage Ind Bronze ID Health Insurance Plan, Variant (38128ID0140003-01) offer Disease Management Programs for Asthma?
Yes, the Engage Ind Bronze ID Health Insurance Plan Variant
38128ID0140003-01 offers Disease
Management Program for Asthma.
Does Engage Ind Bronze ID Health Insurance Plan, Variant (38128ID0140003-01) offer Disease Management Programs for Diabetes?
Yes, the Engage Ind Bronze ID Health Insurance Plan Variant
38128ID0140003-01 offers Disease
Management Program for Diabetes.
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