Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) - 57845WI0040013 Health Insurance Plan
Medica Community Health Plan health insurance plan with the Plan ID 57845WI0040013. The plan is called Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness).
| Health Insurance Plan ID | 57845WI0040013 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Wisconsin | ||||||||||||||||||
| Health Insurance Issuer | Medica Community Health Plan | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 57845WI0040013-00 | ||||||||||||||||||
| Provider Network(s) | ['WIN002'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Tue, 20 Jul 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant 57845WI0040013-00 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 3 |
| Business Year | 2022 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Catastrophic Off Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 100% |
| Formulary ID | WIF013 |
| Formulary URL | URL |
| HIOS Product ID | 57845WI004 |
| Import Date | 7/20/2021 10:32 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 57845 |
| Issuer Marketplace Marketing Name | Medica |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Catastrophic |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | WIN002 |
| 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 Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 57845WI0040013-00 |
| Plan Marketing Name | Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) |
| Plan Type | EPO |
| Plan Variant Marketing Name | Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,700 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $90 |
| SBC Scenario, Having Diabetes, Deductible | $2,300 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | WIS002 |
| Source Name | HIOS |
| Plan ID | 57845WI0040013 |
| State Code | WI |
| 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 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person 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 Per Group | $17400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $8700 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,700 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person 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 Per Group | $17400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8700 per person |
| 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 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 | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, 57845WI0040013
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness), 57845WI0040013 Health Insurance Plan, 57845WI0040013
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Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, 57845WI0040013 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (57845WI0040013) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Does (57845WI0040013) Health Insurance Plan, Variant (57845WI0040013-00) have Out Of Country Coverage?
Yes. Details: Emergency Services
Does (57845WI0040013) Health Insurance Plan, Variant (57845WI0040013-00) have Out of Service Area Coverage?
Yes. Details: Emergency Services
Does (57845WI0040013) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs for Asthma?
Yes, the Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant
57845WI0040013-00 offers Disease
Management Program for Asthma.
Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs for Heart disease?
Yes, the Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant
57845WI0040013-00 offers Disease
Management Program for Heart disease.
Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs for Depression?
Yes, the Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant
57845WI0040013-00 offers Disease
Management Program for Depression.
Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs for Diabetes?
Yes, the Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant
57845WI0040013-00 offers Disease
Management Program for Diabetes.
Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant
57845WI0040013-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs for Low back pain?
Yes, the Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant
57845WI0040013-00 offers Disease
Management Program for Low back pain.
Does Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan, Variant (57845WI0040013-00) offer Disease Management Programs for Pregnancy?
Yes, the Medica Individual Choice Catastrophic ($0 Virtual Care + Online Wellness) Health Insurance Plan Variant
57845WI0040013-00 offers Disease
Management Program for Pregnancy.
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