IHC Gold EPO Regional Preferred $30/$50 - 91762NJ0070010 Health Insurance Plan
AmeriHealth Insurance Company of New Jersey health insurance plan with the Plan ID 91762NJ0070010. The plan is called IHC Gold EPO Regional Preferred $30/$50.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.96% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.04% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 91762NJ0070010 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New Jersey | ||||||||||||||||||
| Health Insurance Issuer | AmeriHealth Insurance Company of New Jersey | ||||||||||||||||||
| Health Insurance Plan Variant | 91762NJ0070010-01 | ||||||||||||||||||
| 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 - 91762NJ0070010-01 |
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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 |
IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan Variant 91762NJ0070010-01 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 |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, Pregnancy, Weight Loss Programs, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 99.95% |
| First Tier Utilization | 100% |
| Formulary ID | NJF021 |
| HIOS Product ID | 91762NJ007 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 81.96% |
| Issuer ID | 91762 |
| 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 person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $1700 per person | $3400 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $1,700 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Gold |
| 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 | Emergency Care is covered outside of the service area. |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 91762NJ0070010-01 |
| Plan Marketing Name | IHC Gold EPO Regional Preferred $30/$50 |
| Plan Type | EPO |
| Plan Variant Marketing Name | IHC Gold EPO Regional Preferred $30/$50 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,000 |
| SBC Scenario, Having a Baby, Copayment | $80 |
| SBC Scenario, Having a Baby, Deductible | $1,500 |
| SBC Scenario, Having a Baby, Limit | $10 |
| SBC Scenario, Having Diabetes, Coinsurance | $2,500 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $60 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NJS001 |
| Source Name | SERFF |
| Plan ID | 91762NJ0070010 |
| 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 |
| 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 | Yes |
Copay & Coinsurance of IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, 91762NJ0070010
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about IHC Gold EPO Regional Preferred $30/$50, 91762NJ0070010 Health Insurance Plan, 91762NJ0070010
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Does IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, 91762NJ0070010 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (91762NJ0070010) Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy, Weight Loss Programs, High Blood Pressure & High Cholesterol
Does (91762NJ0070010) Health Insurance Plan, Variant (91762NJ0070010-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (91762NJ0070010) Health Insurance Plan, Variant (91762NJ0070010-01) have Out of Service Area Coverage?
Yes. Details: Emergency Care is covered outside of the service area.
Does (91762NJ0070010) Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy, Weight Loss Programs, High Blood Pressure & High Cholesterol
Does IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs for Asthma?
Yes, the IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan Variant
91762NJ0070010-01 offers Disease
Management Program for Asthma.
Does IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs for Heart disease?
Yes, the IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan Variant
91762NJ0070010-01 offers Disease
Management Program for Heart disease.
Does IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs for Diabetes?
Yes, the IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan Variant
91762NJ0070010-01 offers Disease
Management Program for Diabetes.
Does IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan Variant
91762NJ0070010-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs for Pregnancy?
Yes, the IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan Variant
91762NJ0070010-01 offers Disease
Management Program for Pregnancy.
Does IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan, Variant (91762NJ0070010-01) offer Disease Management Programs for Weight loss programs?
Yes, the IHC Gold EPO Regional Preferred $30/$50 Health Insurance Plan Variant
91762NJ0070010-01 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