Medica Applause Bronze Copay (First 3) - 31616MN0420031 Health Insurance Plan

Medica Insurance Company health insurance plan with the Plan ID 31616MN0420031. The plan is called Medica Applause Bronze Copay (First 3).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.23% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.77% 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 64.11% (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 35.89% 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 31616MN0420031
Health Insurance Plan Year 2024
State Minnesota
Health Insurance Issuer Medica Insurance Company
Health Insurance Plan Variant 31616MN0420031-01
Provider Network(s) ['MNN011']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Minnesota 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 - 31616MN0420031-01

Open to Indians below 300% FPL - 31616MN0420031-02

Open to Indians above 300% FPL - 31616MN0420031-03

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.641115317
Begin Primary Care Deductible Coinsurance After Number Of Copays 3
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
EHB Percent of Total Premium 100%
First Tier Utilization 100%
Formulary ID MNF007
HIOS Product ID 31616MN042
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 64.23%
Issuer ID 31616
Market Coverage Individual
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 MNN011
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Services
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 31616MN0420031-01
Plan Marketing Name Medica Applause Bronze Copay (First 3)
Plan Type EPO
Plan Variant Marketing Name Medica Applause Bronze Copay (First 3)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,400
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $7,200
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $700
SBC Scenario, Having Diabetes, Deductible $1,100
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $40
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,600
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MNS023
Source Name SERFF
Plan ID 31616MN0420031
State Code MN
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 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $7200 per person | $14400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $7,200
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 $9450 per person | $18900 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,450
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 Medica Applause Bronze Copay (First 3) Health Insurance Plan, 31616MN0420031

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

Frequently Asked Questions(FAQ) about Medica Applause Bronze Copay (First 3), 31616MN0420031 Health Insurance Plan, 31616MN0420031

  • Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, 31616MN0420031 support Mail Ordering?

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

  • Does (31616MN0420031) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma

    Does (31616MN0420031) Health Insurance Plan, Variant (31616MN0420031-01) have Out Of Country Coverage?

    Yes. Details: Emergency Services

    Does (31616MN0420031) Health Insurance Plan, Variant (31616MN0420031-01) have Out of Service Area Coverage?

    Yes. Details: Emergency Services

    Does (31616MN0420031) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma

    Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs for Asthma?

    Yes, the Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 offers Disease Management Program for Asthma.

    Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs for Heart disease?

    Yes, the Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 offers Disease Management Program for Heart disease.

    Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs for Depression?

    Yes, the Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 offers Disease Management Program for Depression.

    Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs for Diabetes?

    Yes, the Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 offers Disease Management Program for Diabetes.

    Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs for Low back pain?

    Yes, the Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 offers Disease Management Program for Low back pain.

    Does Medica Applause Bronze Copay (First 3) Health Insurance Plan, Variant (31616MN0420031-01) offer Disease Management Programs for Pregnancy?

    Yes, the Medica Applause Bronze Copay (First 3) Health Insurance Plan Variant 31616MN0420031-01 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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