McLaren Silver Exchange Rewards - 74917MI0020017 Health Insurance Plan
McLaren Health Plan Community health insurance plan with the Plan ID 74917MI0020017. The plan is called McLaren Silver Exchange Rewards.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.02% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.98% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 72.77% (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 27.23% 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 | 74917MI0020017 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Michigan | ||||||||||||||||||
| Health Insurance Issuer | McLaren Health Plan Community | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Health Insurance Plan Variant | 74917MI0020017-00 | ||||||||||||||||||
| Provider Network(s) | ['MIN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 74917MI0020017-00 Standard On Exchange Plan - 74917MI0020017-01 Open to Indians below 300% FPL - 74917MI0020017-02 Open to Indians above 300% FPL - 74917MI0020017-03 73% AV Silver Plan - 74917MI0020017-04 |
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| Last Plan Update Date | Thu, 12 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Benefits of McLaren Silver Exchange Rewards Health Insurance Plan, 74917MI0020017-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
NO | ||
| Accidental Dental
|
NO | ||
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Bariatric Surgery
Limit: 1.0 Procedure(s) per Lifetime |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
NO | ||
| Chemotherapy
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Chiropractic Care
Limit: 30.0 Visit(s) per Year Limit combined with OT and PT. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Cosmetic Surgery
|
NO | ||
| Delivery and All Inpatient Services for Maternity Care
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Dental Check-Up for Children
|
NO | ||
| Diabetes Education
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Dialysis
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Durable Medical Equipment
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Emergency Room Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
No Charge after deductible |
| Emergency Transportation/Ambulance
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
No Charge after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Gender Affirming Care
|
NO | ||
| Generic Drugs
|
YES | Tier 1: $10.00 Tier 2: $10.00 |
100.00% |
| Habilitation Services
Limit: 30.0 Visit(s) per Year Yearly limits: PT and OT: 30 visits, Speech: 30 visits. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Hearing Aids
|
NO | ||
| Home Health Care Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Hospice Services
Coverage includes inpatient and outpatient hospice care. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Infertility Treatment
Underlying causes only. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Infusion Therapy
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Inpatient Physician and Surgical Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Long-Term/Custodial Nursing Home Care
|
NO | ||
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
NO | ||
| Mental/Behavioral Health Inpatient Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Non-Preferred Brand Drugs
|
YES | Tier 1: 50.00% Tier 2: 50.00% |
100.00% |
| Nutritional Counseling
Limit: 6.0 Visit(s) per Year Dietician Services. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 30.0 Visit(s) per Year PT/OT/Chiro - combined visits per contract year; 30 ST per contract year; 30 cardiac/pulmonary visits per contract year. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Outpatient Surgery Physician/Surgical Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Preferred Brand Drugs
|
YES | Tier 1: $75.00 Tier 2: $75.00 |
100.00% |
| Prenatal and Postnatal Care
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Preventive Care/Screening/Immunization
|
YES | Tier 1: 0.00% Tier 2: 0.00% |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Private-Duty Nursing
|
NO | ||
| Prosthetic Devices
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Radiation
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Reconstructive Surgery
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 30.0 Visit(s) per Year Combined with chiro. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Rehabilitative Speech Therapy
Limit: 30.0 Visit(s) per Year |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
Limit: 1.0 Exam(s) per Year |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Routine Foot Care
|
NO | ||
| Skilled Nursing Facility
Limit: 45.0 Days per Year |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Specialist Visit
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Specialty Drugs
|
YES | Tier 1: 50.00% Tier 2: 50.00% |
100.00% |
| Substance Abuse Disorder Inpatient Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Transplant
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental X-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis. |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Urgent Care Centers or Facilities
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
No Charge after deductible |
| Weight Loss Programs
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Well Baby Visits and Care
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| X-rays and Diagnostic Imaging
|
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
McLaren Silver Exchange Rewards Health Insurance Plan Variant 74917MI0020017-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.727676846 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 2), Family Per Group | $0 per group |
| Drug EHB Deductible, In Network (Tier 2), Family Per Person | $0 per person |
| Drug EHB Deductible, In Network (Tier 2), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 0.9997 |
| First Tier Utilization | 36% |
| Formulary ID | MIF004 |
| Formulary URL | URL |
| HIOS Product ID | 74917MI002 |
| Import Date | 1/12/2023 20:00 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 70.02% |
| Issuer ID | 74917 |
| Issuer Marketplace Marketing Name | McLaren Health Plan Community |
| 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 Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $4000 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $2000 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 0.00% |
| Medical EHB Deductible, In Network (Tier 2), Family Per Group | $16500 per group |
| Medical EHB Deductible, In Network (Tier 2), Family Per Person | $8250 per person |
| Medical EHB Deductible, In Network (Tier 2), Individual | $8,250 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Silver |
| Multiple In Network Tiers | Yes |
| National Network | Yes |
| Network ID | MIN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergemcy |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 74917MI0020017-00 |
| Plan Marketing Name | McLaren Silver Exchange Rewards |
| Plan Type | HMO |
| Plan Variant Marketing Name | McLaren Silver Exchange Rewards |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,250 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $1,900 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| 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 |
| Second Tier Utilization | 64% |
| Service Area ID | MIS001 |
| Source Name | SERFF |
| Plan ID | 74917MI0020017 |
| State Code | MI |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person 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 Per Group | $16500 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8250 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,250 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $16500 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $8250 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $8,250 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of McLaren Silver Exchange Rewards Health Insurance Plan, 74917MI0020017
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about McLaren Silver Exchange Rewards, 74917MI0020017 Health Insurance Plan, 74917MI0020017
-
Does McLaren Silver Exchange Rewards Health Insurance Plan, 74917MI0020017 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (74917MI0020017) Health Insurance Plan, Variant (74917MI0020017-00) have Out Of Country Coverage?
Does (74917MI0020017) Health Insurance Plan, Variant (74917MI0020017-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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