Moda Health Plan, Inc health insurance plan with the Plan ID 80588ID0010005. The plan is called Moda Select Bronze 8900 + Vision Exam.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.74% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.26% of the costs of all covered benefits (according to the Issuer).
Health Insurance Plan ID | 80588ID0010005 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Idaho | ||||||||||||||||||
Health Insurance Issuer | Moda Health Plan, Inc | ||||||||||||||||||
Health Insurance Plan Variant | 80588ID0010005-01 | ||||||||||||||||||
Provider Network(s) | ['IDN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
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Available Variants of the Health Plan | Standard On Exchange Plan - 80588ID0010005-01 |
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Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 07 May 2024 06:08 GMT |
Plan Attribute | Value |
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Business Year | 2023 |
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 | Diabetes |
EHB Percent of Total Premium | 99.79% |
First Tier Utilization | 100% |
Formulary ID | IDF005 |
HIOS Product ID | 80588ID001 |
Import Date | 1/23/2023 |
HSA Eligible | No |
IsItANewPlan | New |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | No |
Issuer Actuarial Value | 64.74% |
Issuer ID | 80588 |
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 | Yes |
Network ID | IDN001 |
Out of Country Coverage | No |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Out of Network/ Travel Network |
Plan Effective Date | 1/1/2023 |
Plan Expiration Date | 12/31/2023 |
Plan ID (Standard Component ID with Variant) | 80588ID0010005-01 |
Plan Marketing Name | Moda Select Bronze 8900 + Vision Exam |
Plan Type | POS |
Plan Variant Marketing Name | Moda Select Bronze 8900 + Vision Exam |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $0 |
SBC Scenario, Having a Baby, Copayment | $0 |
SBC Scenario, Having a Baby, Deductible | $8,900 |
SBC Scenario, Having a Baby, Limit | $50 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $400 |
SBC Scenario, Having Diabetes, Deductible | $4,500 |
SBC Scenario, Having Diabetes, Limit | $20 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,300 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | IDS001 |
Source Name | SERFF |
Plan ID | 80588ID0010005 |
State Code | ID |
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 | 0.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $8900 per person | $17800 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,900 |
TEHBDedOutofNetFamily | $17800 per person | $35600 per group |
Combined Medical and Drug EHB Deductible, Out of Network, Individual | $17,800 |
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), Out of Network, Family | $89000 per person | $178000 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $89,000 |
Unique Plan Design | Yes |
Version Number | 1 |
Wellness Program Offered | No |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 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