Gold Classic- PCP Saver - 23818NJ0010007 Health Insurance Plan
Oscar Garden State Insurance Corporation health insurance plan with the Plan ID 23818NJ0010007. The plan is called Gold Classic- PCP Saver.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 80.27% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 19.73% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 23818NJ0010007 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New Jersey | ||||||||||||||||||
| Health Insurance Issuer | Oscar Garden State Insurance Corporation | ||||||||||||||||||
| Health Insurance Plan Variant | 23818NJ0010007-01 | ||||||||||||||||||
| Provider Network(s) | ['NJN001'] | ||||||||||||||||||
| 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 - 23818NJ0010007-01 |
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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 Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant 23818NJ0010007-01 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 |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 99.99% |
| First Tier Utilization | 100% |
| Formulary ID | NJF001 |
| HIOS Product ID | 23818NJ001 |
| 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 | 80.27% |
| Issuer ID | 23818 |
| 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 | NJN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency and Urgent Services only |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 23818NJ0010007-01 |
| Plan Marketing Name | Gold Classic- PCP Saver |
| Plan Type | EPO |
| Plan Variant Marketing Name | Gold Classic- PCP Saver ($0 Virtual Care) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,600 |
| SBC Scenario, Having a Baby, Copayment | $200 |
| SBC Scenario, Having a Baby, Deductible | $1,750 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $700 |
| SBC Scenario, Having Diabetes, Copayment | $300 |
| SBC Scenario, Having Diabetes, Deductible | $1,750 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $30 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,750 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NJS001 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $150 |
| Plan ID | 23818NJ0010007 |
| State Code | NJ |
| 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $1750 per person | $3500 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,750 |
| 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 | $7000 per person | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,000 |
| 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 Classic- PCP Saver Health Insurance Plan, 23818NJ0010007
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Gold Classic- PCP Saver, 23818NJ0010007 Health Insurance Plan, 23818NJ0010007
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Does Gold Classic- PCP Saver Health Insurance Plan, 23818NJ0010007 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (23818NJ0010007) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does (23818NJ0010007) Health Insurance Plan, Variant (23818NJ0010007-01) have Out Of Country Coverage?
Yes. Details: Emergency Services Only
Does (23818NJ0010007) Health Insurance Plan, Variant (23818NJ0010007-01) have Out of Service Area Coverage?
Yes. Details: Emergency and Urgent Services only
Does (23818NJ0010007) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for Asthma?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 offers Disease
Management Program for Asthma.
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for Heart disease?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 offers Disease
Management Program for Heart disease.
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for Depression?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 offers Disease
Management Program for Depression.
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for Diabetes?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 offers Disease
Management Program for Diabetes.
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for Low back pain?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 offers Disease
Management Program for Low back pain.
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for Pregnancy?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 offers Disease
Management Program for Pregnancy.
Does Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan, Variant (23818NJ0010007-01) offer Disease Management Programs for Weight loss programs?
Yes, the Gold Classic- PCP Saver ($0 Virtual Care) Health Insurance Plan Variant
23818NJ0010007-01 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