HA Gold Plan 2 - 13262AR0230003 Health Insurance Plan
HMO Partners, Inc. health insurance plan with the Plan ID 13262AR0230003. The plan is called HA Gold Plan 2.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 77.20% (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 22.80% 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 | 13262AR0230003 | ||||||||||||||||||
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| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Arkansas | ||||||||||||||||||
| Health Insurance Issuer | HMO Partners, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 13262AR0230003-00 | ||||||||||||||||||
| Provider Network(s) | ['ARN001'] | ||||||||||||||||||
| 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 Off Exchange Plan - 13262AR0230003-00 Standard On Exchange Plan - 13262AR0230003-01 |
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| Last Plan Update Date | Tue, 14 Sep 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
HA Gold Plan 2 Health Insurance Plan Variant 13262AR0230003-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.77200783 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2022 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 40.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $2500 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $1250 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $1,250 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| EHB Percent of Total Premium | 0.9973 |
| First Tier Utilization | 100% |
| Formulary ID | ARF001 |
| Formulary URL | URL |
| HIOS Product ID | 13262AR023 |
| Import Date | 9/14/2021 20:00 |
| 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 | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 13262 |
| Issuer Marketplace Marketing Name | Health Advantage |
| 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 Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 40.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | $18000 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $9000 per person |
| Medical EHB Deductible, Out of Network, Individual | $9,000 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | ARN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Care |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Benefit Reduction |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 13262AR0230003-00 |
| Plan Marketing Name | HA Gold Plan 2 |
| Plan Type | POS |
| Plan Variant Marketing Name | HA Gold Plan 2 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $5,100 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $40 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $1,300 |
| SBC Scenario, Having Diabetes, Limit | $60 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $400 |
| 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 | ARS001 |
| Source Name | SERFF |
| Plan ID | 13262AR0230003 |
| State Code | AR |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person 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 Per Group | $15000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $34000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $17000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $17,000 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | Yes |
Copay & Coinsurance of HA Gold Plan 2 Health Insurance Plan, 13262AR0230003
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about HA Gold Plan 2, 13262AR0230003 Health Insurance Plan, 13262AR0230003
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Does HA Gold Plan 2 Health Insurance Plan, 13262AR0230003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (13262AR0230003) Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does (13262AR0230003) Health Insurance Plan, Variant (13262AR0230003-00) have Out Of Country Coverage?
Yes. Details: Emergency Care
Does (13262AR0230003) Health Insurance Plan, Variant (13262AR0230003-00) have Out of Service Area Coverage?
Yes. Details: Benefit Reduction
Does (13262AR0230003) Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for Asthma?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 offers Disease
Management Program for Asthma.
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for Heart disease?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 offers Disease
Management Program for Heart disease.
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for Depression?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 offers Disease
Management Program for Depression.
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for Diabetes?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 offers Disease
Management Program for Diabetes.
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for Low back pain?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 offers Disease
Management Program for Low back pain.
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for Pregnancy?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 offers Disease
Management Program for Pregnancy.
Does HA Gold Plan 2 Health Insurance Plan, Variant (13262AR0230003-00) offer Disease Management Programs for Weight loss programs?
Yes, the HA Gold Plan 2 Health Insurance Plan Variant
13262AR0230003-00 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