Geisinger Marketplace All-Access HMO 25/50/2500 - 22444PA0010157 Health Insurance Plan
Geisinger Health Plan health insurance plan with the Plan ID 22444PA0010157. The plan is called Geisinger Marketplace All-Access HMO 25/50/2500.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 79.84% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 20.16% 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 79.54% (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 20.46% 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 | 22444PA0010157 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | Geisinger Health Plan | ||||||||||||||||||
| Health Insurance Plan Variant | 22444PA0010157-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN001'] | ||||||||||||||||||
| 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 - 22444PA0010157-01 |
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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 |
Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant 22444PA0010157-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.795398492 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $500 per person | $1000 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $500 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | PAF009 |
| HIOS Product ID | 22444PA001 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 79.84% |
| Issuer ID | 22444 |
| 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 person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $2500 per person | $5000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $2,500 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | PAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergent and urgent care covered |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergent and urgent care covered. Other services covered with precertification. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 22444PA0010157-01 |
| Plan Level Exclusions | Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Adult Dental Care, Adult Orthodontia |
| Plan Marketing Name | Geisinger Marketplace All-Access HMO 25/50/2500 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Geisinger Marketplace All-Access HMO 25/50/2500 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,800 |
| SBC Scenario, Having a Baby, Copayment | $200 |
| SBC Scenario, Having a Baby, Deductible | $2,500 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $200 |
| SBC Scenario, Having Diabetes, Limit | $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 | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | PAS001 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $6,500 |
| Plan ID | 22444PA0010157 |
| State Code | PA |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | per person not applicable | per group 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 | $6500 per person | $13000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $6,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, 22444PA0010157
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Geisinger Marketplace All-Access HMO 25/50/2500, 22444PA0010157 Health Insurance Plan, 22444PA0010157
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Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, 22444PA0010157 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (22444PA0010157) Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, High Blood Pressure & High Cholesterol
Does (22444PA0010157) Health Insurance Plan, Variant (22444PA0010157-01) have Out Of Country Coverage?
Yes. Details: Emergent and urgent care covered
Does (22444PA0010157) Health Insurance Plan, Variant (22444PA0010157-01) have Out of Service Area Coverage?
Yes. Details: Emergent and urgent care covered. Other services covered with precertification.
Does (22444PA0010157) Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, High Blood Pressure & High Cholesterol
Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs for Asthma?
Yes, the Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant
22444PA0010157-01 offers Disease
Management Program for Asthma.
Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs for Heart disease?
Yes, the Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant
22444PA0010157-01 offers Disease
Management Program for Heart disease.
Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs for Depression?
Yes, the Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant
22444PA0010157-01 offers Disease
Management Program for Depression.
Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs for Diabetes?
Yes, the Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant
22444PA0010157-01 offers Disease
Management Program for Diabetes.
Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant
22444PA0010157-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs for Pregnancy?
Yes, the Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant
22444PA0010157-01 offers Disease
Management Program for Pregnancy.
Does Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan, Variant (22444PA0010157-01) offer Disease Management Programs for Weight loss programs?
Yes, the Geisinger Marketplace All-Access HMO 25/50/2500 Health Insurance Plan Variant
22444PA0010157-01 offers Disease
Management Program for Weight loss programs.
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