KP OR Silver 4000/45 3T POS w/Massage - 71287OR0440049 Health Insurance Plan

Kaiser Foundation Healthplan of the NW health insurance plan with the Plan ID 71287OR0440049. The plan is called KP OR Silver 4000/45 3T POS w/Massage.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.42% (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 29.58% 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 71287OR0440049
Health Insurance Plan Year 2023
State Oregon
Health Insurance Issuer Kaiser Foundation Healthplan of the NW
Health Insurance Plan Variant 71287OR0440049-01
Provider Network(s) ['ORN003']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT).

Providers Oregon All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard On Exchange Plan - 71287OR0440049-01

Last Plan Update Date Mon, 23 Jan 2023 00:00 GMT
Last Import Date Tue, 30 Apr 2024 06:06 GMT

KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.704191212
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered Yes
CSR Variation Type Standard Silver 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 75%
Formulary ID ORF019
HIOS Product ID 71287OR044
HSA/HRA Employer Contribution No
Import Date 1/23/2023
HSA Eligible No
IsItANewPlan New
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 Silver
Multiple In Network Tiers Yes
National Network Yes
Network ID ORN003
Out of Country Coverage Yes
Out of Country Coverage Description Emergency medical conditions including prescription drugs and other covered services, refer to the EOC
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency medical conditions including prescription drugs and other covered services, refer to the EOC
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 71287OR0440049-01
Plan Marketing Name KP OR Silver 4000/45 3T POS w/Massage
Plan Type POS
Plan Variant Marketing Name KP OR Silver 4000/45 3T POS w/Massage
QHP/Non QHP On the Exchange
SBC Scenario, Having a Baby, Coinsurance $1,800
SBC Scenario, Having a Baby, Copayment $300
SBC Scenario, Having a Baby, Deductible $4,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $100
SBC Scenario, Having Diabetes, Copayment $1,500
SBC Scenario, Having Diabetes, Deductible $70
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $500
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,900
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 25%
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 71287OR0440049
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 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $4000 per person | $8000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $4,000
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance 45.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family $6000 per person | $12000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $6,000
TEHBDedOutofNetFamily $7000 per person | $14000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Individual $7,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $8900 per person | $17800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,900
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family $8900 per person | $17800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $8,900
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $14000 per person | $28000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $14,000
Unique Plan Design No
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, 71287OR0440049

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about KP OR Silver 4000/45 3T POS w/Massage, 71287OR0440049 Health Insurance Plan, 71287OR0440049

  • Does KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, 71287OR0440049 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (71287OR0440049) Health Insurance Plan, Variant (71287OR0440049-01) 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 (71287OR0440049) Health Insurance Plan, Variant (71287OR0440049-01) have Out Of Country Coverage?

    Yes. Details: Emergency medical conditions including prescription drugs and other covered services, refer to the EOC

    Does (71287OR0440049) Health Insurance Plan, Variant (71287OR0440049-01) have Out of Service Area Coverage?

    Yes. Details: Emergency medical conditions including prescription drugs and other covered services, refer to the EOC

    Does (71287OR0440049) Health Insurance Plan, Variant (71287OR0440049-01) 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 Silver 4000/45 3T POS w/Massage Health Insurance Plan, Variant (71287OR0440049-01) offer Disease Management Programs for Asthma?

    Yes, the KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 offers Disease Management Program for Asthma.

    Does KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, Variant (71287OR0440049-01) offer Disease Management Programs for Heart disease?

    Yes, the KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 offers Disease Management Program for Heart disease.

    Does KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, Variant (71287OR0440049-01) offer Disease Management Programs for Depression?

    Yes, the KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 offers Disease Management Program for Depression.

    Does KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, Variant (71287OR0440049-01) offer Disease Management Programs for Diabetes?

    Yes, the KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 offers Disease Management Program for Diabetes.

    Does KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, Variant (71287OR0440049-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, Variant (71287OR0440049-01) offer Disease Management Programs for Low back pain?

    Yes, the KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 offers Disease Management Program for Low back pain.

    Does KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan, Variant (71287OR0440049-01) offer Disease Management Programs for Pregnancy?

    Yes, the KP OR Silver 4000/45 3T POS w/Massage Health Insurance Plan Variant 71287OR0440049-01 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