Horizon Advantage EPO Essentials - 91661NJ2280001 Health Insurance Plan
Horizon Healthcare Services, Inc. health insurance plan with the Plan ID 91661NJ2280001. The plan is called Horizon Advantage EPO Essentials.
| Health Insurance Plan ID | 91661NJ2280001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New Jersey | ||||||||||||||||||
| Health Insurance Issuer | Horizon Healthcare Services, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 91661NJ2280001-01 | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Horizon Advantage EPO Essentials Health Insurance Plan Variant 91661NJ2280001-01 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 3 |
| 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, Pregnancy |
| EHB Percent of Total Premium | 99.75% |
| First Tier Utilization | 100% |
| Formulary ID | NJF005 |
| HIOS Product ID | 91661NJ228 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 91661 |
| 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 | NJN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Only to true medical emergencies and accidental injuries. |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 91661NJ2280001-01 |
| Plan Marketing Name | Horizon Advantage EPO Essentials |
| Plan Type | EPO |
| Plan Variant Marketing Name | Horizon Advantage EPO Essentials |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $4,600 |
| 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 | $2,300 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NJS001 |
| Source Name | SERFF |
| Plan ID | 91661NJ2280001 |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $9100 per person | $18200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,100 |
| 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 Horizon Advantage EPO Essentials Health Insurance Plan, 91661NJ2280001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Horizon Advantage EPO Essentials, 91661NJ2280001 Health Insurance Plan, 91661NJ2280001
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Does Horizon Advantage EPO Essentials Health Insurance Plan, 91661NJ2280001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (91661NJ2280001) Health Insurance Plan, Variant (91661NJ2280001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does (91661NJ2280001) Health Insurance Plan, Variant (91661NJ2280001-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (91661NJ2280001) Health Insurance Plan, Variant (91661NJ2280001-01) have Out of Service Area Coverage?
Yes. Details: Only to true medical emergencies and accidental injuries.
Does (91661NJ2280001) Health Insurance Plan, Variant (91661NJ2280001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does Horizon Advantage EPO Essentials Health Insurance Plan, Variant (91661NJ2280001-01) offer Disease Management Programs for Asthma?
Yes, the Horizon Advantage EPO Essentials Health Insurance Plan Variant
91661NJ2280001-01 offers Disease
Management Program for Asthma.
Does Horizon Advantage EPO Essentials Health Insurance Plan, Variant (91661NJ2280001-01) offer Disease Management Programs for Heart disease?
Yes, the Horizon Advantage EPO Essentials Health Insurance Plan Variant
91661NJ2280001-01 offers Disease
Management Program for Heart disease.
Does Horizon Advantage EPO Essentials Health Insurance Plan, Variant (91661NJ2280001-01) offer Disease Management Programs for Depression?
Yes, the Horizon Advantage EPO Essentials Health Insurance Plan Variant
91661NJ2280001-01 offers Disease
Management Program for Depression.
Does Horizon Advantage EPO Essentials Health Insurance Plan, Variant (91661NJ2280001-01) offer Disease Management Programs for Diabetes?
Yes, the Horizon Advantage EPO Essentials Health Insurance Plan Variant
91661NJ2280001-01 offers Disease
Management Program for Diabetes.
Does Horizon Advantage EPO Essentials Health Insurance Plan, Variant (91661NJ2280001-01) offer Disease Management Programs for Pregnancy?
Yes, the Horizon Advantage EPO Essentials Health Insurance Plan Variant
91661NJ2280001-01 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