Gold 2000 With Vision Exam Individual and Family Network - 71281WA1400002 Health Insurance Plan
Regence BlueCross BlueShield of Oregon health insurance plan with the Plan ID 71281WA1400002. The plan is called Gold 2000 With Vision Exam Individual and Family Network.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.26% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.74% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 71281WA1400002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Washington | ||||||||||||||||||
| Health Insurance Issuer | Regence BlueCross BlueShield of Oregon | ||||||||||||||||||
| Health Insurance Plan Variant | 71281WA1400002-01 | ||||||||||||||||||
| Provider Network(s) | ['WAN001'] | ||||||||||||||||||
| 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 - 71281WA1400002-01 |
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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 |
Gold 2000 With Vision Exam Individual and Family Network Health Insurance Plan Variant 71281WA1400002-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 99.46% |
| First Tier Utilization | 100% |
| Formulary ID | WAF005 |
| HIOS Product ID | 71281WA140 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 78.26% |
| Issuer ID | 71281 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | WAN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 71281WA1400002-01 |
| Plan Marketing Name | Gold 2000 With Vision Exam Individual and Family Network |
| Plan Type | EPO |
| Plan Variant Marketing Name | Gold 2000 With Vision Exam Individual and Family Network |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $1,022 |
| SBC Scenario, Having a Baby, Copayment | $9 |
| SBC Scenario, Having a Baby, Deductible | $2,000 |
| SBC Scenario, Having a Baby, Limit | $61 |
| SBC Scenario, Having Diabetes, Coinsurance | $937 |
| SBC Scenario, Having Diabetes, Copayment | $331 |
| SBC Scenario, Having Diabetes, Deductible | $877 |
| SBC Scenario, Having Diabetes, Limit | $178 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $45 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $215 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,000 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | WAS001 |
| Source Name | SERFF |
| Plan ID | 71281WA1400002 |
| State Code | WA |
| 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 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| 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 | $2000 per person | $4000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| TEHBDedOutofNetFamily | per person not applicable | per group 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 | $9100 per person | $18200 per group |
| 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 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 | No |
Copay & Coinsurance of Gold 2000 With Vision Exam Individual and Family Network Health Insurance Plan, 71281WA1400002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Gold 2000 With Vision Exam Individual and Family Network, 71281WA1400002 Health Insurance Plan, 71281WA1400002
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Does Gold 2000 With Vision Exam Individual and Family Network Health Insurance Plan, 71281WA1400002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (71281WA1400002) Health Insurance Plan, Variant (71281WA1400002-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (71281WA1400002) Health Insurance Plan, Variant (71281WA1400002-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan).
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