Medica Applause Gold Copay $0 PCP + Rx Copays - 31616MN0420045 Health Insurance Plan

Medica Insurance Company health insurance plan with the Plan ID 31616MN0420045. The plan is called Medica Applause Gold Copay $0 PCP + Rx Copays .

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 78.12% (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 21.88% 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 31616MN0420045
Health Insurance Plan Year 2024
State Minnesota
Health Insurance Issuer Medica Insurance Company
Health Insurance Plan Variant 31616MN0420045-01
Provider Network(s) ['MNN011']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 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 - 31616MN0420045-01

Open to Indians below 300% FPL - 31616MN0420045-02

Open to Indians above 300% FPL - 31616MN0420045-03

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.781159997
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold 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 MNF023
HIOS Product ID 31616MN042
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 31616
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
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) 31616MN0420045-01
Plan Marketing Name Medica Applause Gold Copay $0 PCP + Rx Copays
Plan Type EPO
Plan Variant Marketing Name Medica Applause Gold Copay $0 PCP + Rx Copays
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,500
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $1,600
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $600
SBC Scenario, Having Diabetes, Deductible $1,100
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $300
SBC Scenario, Treatment of a Simple Fracture, Copayment $100
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,600
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MNS011
Source Name SERFF
Plan ID 31616MN0420045
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 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $1600 per person | $3200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,600
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 $8700 per person | $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
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 No

Copay & Coinsurance of Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, 31616MN0420045

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

Frequently Asked Questions(FAQ) about Medica Applause Gold Copay $0 PCP + Rx Copays , 31616MN0420045 Health Insurance Plan, 31616MN0420045

  • Does Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, 31616MN0420045 support Mail Ordering?

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

  • Does (31616MN0420045) Health Insurance Plan, Variant (31616MN0420045-01) 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 (31616MN0420045) Health Insurance Plan, Variant (31616MN0420045-01) have Out Of Country Coverage?

    Yes. Details: Emergency Services

    Does (31616MN0420045) Health Insurance Plan, Variant (31616MN0420045-01) have Out of Service Area Coverage?

    Yes. Details: Emergency Services

    Does (31616MN0420045) Health Insurance Plan, Variant (31616MN0420045-01) 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 Gold Copay $0 PCP + Rx Copays Health Insurance Plan, Variant (31616MN0420045-01) offer Disease Management Programs for Asthma?

    Yes, the Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 offers Disease Management Program for Asthma.

    Does Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, Variant (31616MN0420045-01) offer Disease Management Programs for Heart disease?

    Yes, the Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 offers Disease Management Program for Heart disease.

    Does Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, Variant (31616MN0420045-01) offer Disease Management Programs for Depression?

    Yes, the Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 offers Disease Management Program for Depression.

    Does Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, Variant (31616MN0420045-01) offer Disease Management Programs for Diabetes?

    Yes, the Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 offers Disease Management Program for Diabetes.

    Does Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, Variant (31616MN0420045-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, Variant (31616MN0420045-01) offer Disease Management Programs for Low back pain?

    Yes, the Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 offers Disease Management Program for Low back pain.

    Does Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan, Variant (31616MN0420045-01) offer Disease Management Programs for Pregnancy?

    Yes, the Medica Applause Gold Copay $0 PCP + Rx Copays Health Insurance Plan Variant 31616MN0420045-01 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 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