Friday Silver Zero Deductible - 90617GA0010015 Health Insurance Plan
Friday Health Plans of Georgia Inc health insurance plan with the Plan ID 90617GA0010015. The plan is called Friday Silver Zero Deductible.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 94.02% (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 5.98% 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 | 90617GA0010015 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Georgia | ||||||||||||||||||
| Health Insurance Issuer | Friday Health Plans of Georgia Inc | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 90617GA0010015-06 | ||||||||||||||||||
| Provider Network(s) | ['GAN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 22 Oct 2024 06:47 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 90617GA0010015-00 Standard On Exchange Plan - 90617GA0010015-01 Open to Indians below 300% FPL - 90617GA0010015-02 Open to Indians above 300% FPL - 90617GA0010015-03 73% AV Silver Plan - 90617GA0010015-04 |
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| Last Plan Update Date | Wed, 21 Dec 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 22 Oct 2024 06:47 GMT |
Benefits of Friday Silver Zero Deductible Health Insurance Plan, 90617GA0010015-06
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
NO | ||
| Accidental Dental
|
YES | $500.00 |
100.00% |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Bariatric Surgery
|
NO | ||
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
NO | ||
| Chemotherapy
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Chiropractic Care
Limited to 40 visits per plan year |
YES | 15.00% Coinsurance after deductible |
100.00% |
| Cosmetic Surgery
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Delivery and All Inpatient Services for Maternity Care
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Dental Check-Up for Children
Limit: 2.0 Procedure(s) per Year |
NO | ||
| Diabetes Education
|
YES | No Charge |
100.00% |
| Dialysis
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Durable Medical Equipment
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Emergency Room Services
|
YES | $200.00 |
$200.00 |
| Emergency Transportation/Ambulance
|
YES | 15.00% Coinsurance after deductible |
15.00% Coinsurance after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year |
YES | No Charge |
100.00% |
| Gender Affirming Care
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Generic Drugs
Value displayed reflects the maximum copay / co insurance amount a member could pay. |
YES | No Charge |
100.00% |
| Habilitation Services
Limit: 40.0 Visit(s) per Year Limited to 40 PT/OT/ST Habilitation outpatient visits per therapy per plan year |
YES | $25.00 |
100.00% |
| Hearing Aids
Limit of one hearing aid per year, every 48 months. |
YES | 15.00% Coinsurance after deductible |
100.00% |
| Home Health Care Services
Limit: 120.0 Visit(s) per Year |
YES | 15.00% Coinsurance after deductible |
100.00% |
| Hospice Services
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
|
YES | $150.00 |
100.00% |
| Infertility Treatment
|
NO | ||
| Infusion Therapy
Insulin infusion devices. |
YES | 15.00% Coinsurance after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Inpatient Physician and Surgical Services
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
|
YES | $35.00 |
100.00% |
| Long-Term/Custodial Nursing Home Care
|
NO | ||
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
NO | ||
| Mental/Behavioral Health Inpatient Services
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
|
YES | No Charge |
100.00% |
| Non-Preferred Brand Drugs
Value displayed reflects the maximum copay / co insurance amount a member could pay. |
YES | $75.00 |
100.00% |
| Nutritional Counseling
Limit: 4.0 Visit(s) per Year |
YES | $25.00 |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | No Charge |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 40.0 Visit(s) per Year Limited to 40 PT/OY/ST rehabilitation visits per plan year |
YES | $25.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Preferred Brand Drugs
Value displayed reflects the maximum copay / co insurance amount a member could pay. |
YES | $20.00 |
100.00% |
| Prenatal and Postnatal Care
|
YES | $25.00 |
100.00% |
| Preventive Care/Screening/Immunization
The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
|
YES | No Charge |
100.00% |
| Private-Duty Nursing
|
NO | ||
| Prosthetic Devices
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Radiation
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Reconstructive Surgery
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 40.0 Visit(s) per Year Limited to 40 PT/OY/ST rehabilitation visits per plan year |
YES | $25.00 |
100.00% |
| Rehabilitative Speech Therapy
Limit: 40.0 Visit(s) per Year Limited to 40 PT/OY/ST rehabilitation visits per plan year |
YES | $25.00 |
100.00% |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
|
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year |
YES | No Charge |
100.00% |
| Routine Foot Care
|
NO | ||
| Skilled Nursing Facility
Limit: 60.0 Days per Year |
YES | 15.00% Coinsurance after deductible |
100.00% |
| Specialist Visit
|
YES | $25.00 |
100.00% |
| Specialty Drugs
Value displayed reflects the maximum copay / co insurance amount a member could pay. |
YES | $100.00 |
100.00% |
| Substance Abuse Disorder Inpatient Services
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
|
YES | No Charge |
100.00% |
| Transplant
Limit: 10000.0 Dollars per Procedure Limited to a combined maximum of $10,000 per covered organ transplant. |
YES | 15.00% Coinsurance after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
|
YES | 15.00% Coinsurance after deductible |
100.00% |
| Urgent Care Centers or Facilities
|
YES | $25.00 |
$25.00 |
| Weight Loss Programs
|
YES | $25.00 |
100.00% |
| Well Baby Visits and Care
Care provided for birth through age 5. |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
|
YES | $35.00 |
100.00% |
FRIDAY Silver $0 Deductible 94%: Unlimited $0 Primary Care Visits, $0 Preferred Generic Rx, $0 Mental Health Counseling Health Insurance Plan Variant 90617GA0010015-06 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.940225877 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 94% AV Level Silver Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Diabetes |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 100% |
| Formulary ID | GAF001 |
| Formulary URL | URL |
| HIOS Product ID | 90617GA001 |
| Import Date | 12/21/2022 1:01 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 90617 |
| Issuer Marketplace Marketing Name | Friday Health Plans |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | GAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Urgent and Emergent only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Urgent and Emergent only |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 90617GA0010015-06 |
| Plan Marketing Name | Friday Silver Zero Deductible |
| Plan Type | HMO |
| Plan Variant Marketing Name | FRIDAY Silver $0 Deductible 94%: Unlimited $0 Primary Care Visits, $0 Preferred Generic Rx, $0 Mental Health Counseling |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $700 |
| SBC Scenario, Having a Baby, Copayment | $500 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $100 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | GAS001 |
| Source Name | HIOS |
| Plan ID | 90617GA0010015 |
| State Code | GA |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $2400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $1200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $1,200 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $0 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 10.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person 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 Per Group | $2400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $1200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $1,200 |
| 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 | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Friday Silver Zero Deductible Health Insurance Plan, 90617GA0010015
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Friday Silver Zero Deductible, 90617GA0010015 Health Insurance Plan, 90617GA0010015
-
Does Friday Silver Zero Deductible Health Insurance Plan, 90617GA0010015 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (90617GA0010015) Health Insurance Plan, Variant (90617GA0010015-06) offer Disease Management Programs?
Does (90617GA0010015) Health Insurance Plan, Variant (90617GA0010015-06) have Out Of Country Coverage?
Does (90617GA0010015) Health Insurance Plan, Variant (90617GA0010015-06) have Out of Service Area Coverage?
Does (90617GA0010015) Health Insurance Plan, Variant (90617GA0010015-06) offer Disease Management Programs?
Does FRIDAY Silver $0 Deductible 94%: Unlimited $0 Primary Care Visits, $0 Preferred Generic Rx, $0 Mental Health Counseling Health Insurance Plan, Variant (90617GA0010015-06) offer Disease Management Programs for Diabetes?
Disclaimer: This is based on the import(Date: Tue, 22 Oct 2024 06:47 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