HMO Blue Essential - 42690MA1290014 Health Insurance Plan
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc health insurance plan with the Plan ID 42690MA1290014. The plan is called HMO Blue Essential.
| Health Insurance Plan ID | 42690MA1290014 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Massachusetts | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc | ||||||||||||||||||
| Health Insurance Plan Variant | 42690MA1290014-01 | ||||||||||||||||||
| Provider Network(s) | ['MAN001'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 22 May 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
HMO Blue Essential Health Insurance Plan Variant 42690MA1290014-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Catastrophic On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 99.84% |
| First Tier Utilization | 100% |
| Formulary ID | MAF008 |
| HIOS Product ID | 42690MA129 |
| Import Date | 5/22/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 42690 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Catastrophic |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency and Urgent Care Services only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency and Urgent Care Services only |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 42690MA1290014-01 |
| Plan Marketing Name | HMO Blue Essential |
| Plan Type | HMO |
| Plan Variant Marketing Name | HMO Blue Essential |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,750 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $100 |
| SBC Scenario, Having Diabetes, Deductible | $5,100 |
| 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 | MAS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All professional provider specialists except for OB/GYN, Chiropractor, and Acupuncturist |
| Plan ID | 42690MA1290014 |
| State Code | MA |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $8750 per person | $17500 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,750 |
| 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 | $8750 per person | $17500 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,750 |
| 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 | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of HMO Blue Essential Health Insurance Plan, 42690MA1290014
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about HMO Blue Essential, 42690MA1290014 Health Insurance Plan, 42690MA1290014
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Does HMO Blue Essential Health Insurance Plan, 42690MA1290014 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (42690MA1290014) Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, High Blood Pressure & High Cholesterol
Does (42690MA1290014) Health Insurance Plan, Variant (42690MA1290014-01) have Out Of Country Coverage?
Yes. Details: Emergency and Urgent Care Services only
Does (42690MA1290014) Health Insurance Plan, Variant (42690MA1290014-01) have Out of Service Area Coverage?
Yes. Details: Emergency and Urgent Care Services only
Does (42690MA1290014) Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, High Blood Pressure & High Cholesterol
Does HMO Blue Essential Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs for Asthma?
Yes, the HMO Blue Essential Health Insurance Plan Variant
42690MA1290014-01 offers Disease
Management Program for Asthma.
Does HMO Blue Essential Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs for Heart disease?
Yes, the HMO Blue Essential Health Insurance Plan Variant
42690MA1290014-01 offers Disease
Management Program for Heart disease.
Does HMO Blue Essential Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs for Depression?
Yes, the HMO Blue Essential Health Insurance Plan Variant
42690MA1290014-01 offers Disease
Management Program for Depression.
Does HMO Blue Essential Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs for Diabetes?
Yes, the HMO Blue Essential Health Insurance Plan Variant
42690MA1290014-01 offers Disease
Management Program for Diabetes.
Does HMO Blue Essential Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the HMO Blue Essential Health Insurance Plan Variant
42690MA1290014-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does HMO Blue Essential Health Insurance Plan, Variant (42690MA1290014-01) offer Disease Management Programs for Pregnancy?
Yes, the HMO Blue Essential Health Insurance Plan Variant
42690MA1290014-01 offers Disease
Management Program for Pregnancy.
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