HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental - 41046NY0010036 Health Insurance Plan
Empire BlueCross BlueShield HealthPlus health insurance plan with the Plan ID 41046NY0010036. The plan is called HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.84% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.16% 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 66.52% (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 33.48% 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 | 41046NY0010036 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New York | ||||||||||||||||||
| Health Insurance Issuer | Empire BlueCross BlueShield HealthPlus | ||||||||||||||||||
| Health Insurance Plan Variant | 41046NY0010036-01 | ||||||||||||||||||
| Provider Network(s) | ['NYN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 14 May 2024 06:16 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 41046NY0010036-01 |
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| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 14 May 2024 06:16 GMT |
HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant 41046NY0010036-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.665248043 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 3 |
| Business Year | 2023 |
| Child-Only Offering | Allows Child-Only |
| Composite Rating Offered | No |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Low Back Pain, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 99.60% |
| First Tier Utilization | 100% |
| Formulary ID | NYF002 |
| HIOS Product ID | 41046NY001 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 64.84% |
| Issuer ID | 41046 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | NYN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 41046NY0010036-01 |
| Plan Marketing Name | HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental |
| Plan Type | HMO |
| Plan Variant Marketing Name | HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,500 |
| SBC Scenario, Having a Baby, Deductible | $4,700 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $300 |
| SBC Scenario, Having Diabetes, Deductible | $4,700 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NYS002 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All specialists require referral with the exception of OB/GYN |
| Plan ID | 41046NY0010036 |
| State Code | NY |
| 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 | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $4700 per person | $9400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $4,700 |
| 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 | $8700 per person | $17400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,700 |
| 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 HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, 41046NY0010036
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental, 41046NY0010036 Health Insurance Plan, 41046NY0010036
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Does HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, 41046NY0010036 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (41046NY0010036) Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Low Back Pain, High Blood Pressure & High Cholesterol
Does (41046NY0010036) Health Insurance Plan, Variant (41046NY0010036-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (41046NY0010036) Health Insurance Plan, Variant (41046NY0010036-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan).
Does (41046NY0010036) Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Low Back Pain, High Blood Pressure & High Cholesterol
Does HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs for Asthma?
Yes, the HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010036-01 offers Disease
Management Program for Asthma.
Does HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs for Heart disease?
Yes, the HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010036-01 offers Disease
Management Program for Heart disease.
Does HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs for Depression?
Yes, the HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010036-01 offers Disease
Management Program for Depression.
Does HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs for Diabetes?
Yes, the HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010036-01 offers Disease
Management Program for Diabetes.
Does HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010036-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010036-01) offer Disease Management Programs for Low back pain?
Yes, the HealthPlus Gatekeeper X, Bronze Child Only, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010036-01 offers Disease
Management Program for Low back pain.
Disclaimer: This is based on the import(Date: Tue, 14 May 2024 06:16 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