KP OR Bronze 9000/40 - 71287OR0570007 Health Insurance Plan
Kaiser Foundation Healthplan of the NW health insurance plan with the Plan ID 71287OR0570007. The plan is called KP OR Bronze 9000/40.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 61.95% (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 38.05% 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 | 71287OR0570007 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | Kaiser Foundation Healthplan of the NW | ||||||||||||||||||
| Health Insurance Plan Variant | 71287OR0570007-01 | ||||||||||||||||||
| Provider Network(s) | ['ORN002'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 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, 30 Apr 2024 06:06 GMT |
KP OR Bronze 9000/40 Health Insurance Plan Variant 71287OR0570007-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.619459572 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 3 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | Yes |
| CSR Variation Type | Standard Bronze On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol |
| First Tier Utilization | 100% |
| Formulary ID | ORF012 |
| HIOS Product ID | 71287OR057 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 71287 |
| Market Coverage | SHOP (Small Group) |
| 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 | ORN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency medical conditions, including prescription drugs. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency medical conditions, including prescription drugs. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 71287OR0570007-01 |
| Plan Marketing Name | KP OR Bronze 9000/40 |
| Plan Type | EPO |
| Plan Variant Marketing Name | KP OR Bronze 9000/40 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $100 |
| SBC Scenario, Having Diabetes, Copayment | $900 |
| SBC Scenario, Having Diabetes, Deductible | $200 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $10 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ORS002 |
| Source Name | SERFF |
| Specialist Requiring a Referral | A referral is not required for Outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services, Mental Health Services, Obstetrics/Gynecology, Occupational Health, Opthalmology, and Optometry (routine eye exams), and Social Services. |
| Plan ID | 71287OR0570007 |
| State Code | OR |
| 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 | $9000 per person | $18000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,000 |
| 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 | $9000 per person | $18000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,000 |
| 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 | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of KP OR Bronze 9000/40 Health Insurance Plan, 71287OR0570007
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about KP OR Bronze 9000/40, 71287OR0570007 Health Insurance Plan, 71287OR0570007
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Does KP OR Bronze 9000/40 Health Insurance Plan, 71287OR0570007 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (71287OR0570007) Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol
Does (71287OR0570007) Health Insurance Plan, Variant (71287OR0570007-01) have Out Of Country Coverage?
Yes. Details: Emergency medical conditions, including prescription drugs.
Does (71287OR0570007) Health Insurance Plan, Variant (71287OR0570007-01) have Out of Service Area Coverage?
Yes. Details: Emergency medical conditions, including prescription drugs.
Does (71287OR0570007) Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol
Does KP OR Bronze 9000/40 Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs for Asthma?
Yes, the KP OR Bronze 9000/40 Health Insurance Plan Variant
71287OR0570007-01 offers Disease
Management Program for Asthma.
Does KP OR Bronze 9000/40 Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs for Heart disease?
Yes, the KP OR Bronze 9000/40 Health Insurance Plan Variant
71287OR0570007-01 offers Disease
Management Program for Heart disease.
Does KP OR Bronze 9000/40 Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs for Depression?
Yes, the KP OR Bronze 9000/40 Health Insurance Plan Variant
71287OR0570007-01 offers Disease
Management Program for Depression.
Does KP OR Bronze 9000/40 Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs for Diabetes?
Yes, the KP OR Bronze 9000/40 Health Insurance Plan Variant
71287OR0570007-01 offers Disease
Management Program for Diabetes.
Does KP OR Bronze 9000/40 Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the KP OR Bronze 9000/40 Health Insurance Plan Variant
71287OR0570007-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does KP OR Bronze 9000/40 Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs for Low back pain?
Yes, the KP OR Bronze 9000/40 Health Insurance Plan Variant
71287OR0570007-01 offers Disease
Management Program for Low back pain.
Does KP OR Bronze 9000/40 Health Insurance Plan, Variant (71287OR0570007-01) offer Disease Management Programs for Pregnancy?
Yes, the KP OR Bronze 9000/40 Health Insurance Plan Variant
71287OR0570007-01 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 30 Apr 2024 06:06 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