Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - 17933TX0010001 Health Insurance Plan

Moda Health Plan, Inc. health insurance plan with the Plan ID 17933TX0010001. The plan is called Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 100.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 0.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 17933TX0010001
Health Insurance Plan Year 2025
State Texas
Health Insurance Issuer Moda Health Plan, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 17933TX0010001-02
Provider Network(s) NON-PREFERRED PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 01 Jul 2025 05:26 GMT).

Providers Texas All US States
All 12889 87920
PCP 1559 3292
Allergy 9 15
OB/GYN 131 208
Dentists 12 34
Available Variants of the Health Plan

Standard Off Exchange Plan - 17933TX0010001-00

Standard On Exchange Plan - 17933TX0010001-01

Open to Indians below 300% FPL - 17933TX0010001-02

Open to Indians above 300% FPL - 17933TX0010001-03

Last Plan Update Date Thu, 29 Aug 2024 00:00 GMT
Last Import Date Tue, 01 Jul 2025 05:26 GMT

Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Zero Cost Sharing Plan Variation
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 0.9990000000000001
First Tier Utilization 100%
Formulary ID TXF001
Formulary URL URL
HIOS Product ID 17933TX001
Import Date 2024-08-29 01:02:15
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 Actuarial Value 100.00%
Issuer ID 17933
Issuer Marketplace Marketing Name Moda Health Plan, Inc.
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 TXN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency care only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency care and out-of-area dependent coverage
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 17933TX0010001-02
Plan Marketing Name Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD)
Plan Type EPO
Plan Variant Marketing Name Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $50
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
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 $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID TXS001
Source Name HIOS
Plan ID 17933TX0010001
State Code TX
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 $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
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 $0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $0 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $0
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 Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) Health Insurance Plan, 17933TX0010001

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

Frequently Asked Questions(FAQ) about Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD), 17933TX0010001 Health Insurance Plan, 17933TX0010001

  • Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) Health Insurance Plan, 17933TX0010001 support Mail Ordering?

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

  • Does (17933TX0010001) Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs?

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

    Does (17933TX0010001) Health Insurance Plan, Variant (17933TX0010001-02) have Out Of Country Coverage?

    Yes. Details: Emergency care only

    Does (17933TX0010001) Health Insurance Plan, Variant (17933TX0010001-02) have Out of Service Area Coverage?

    Yes. Details: Emergency care and out-of-area dependent coverage

    Does (17933TX0010001) Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs?

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

    Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs for Asthma?

    Yes, the Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 offers Disease Management Program for Asthma.

    Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs for Heart disease?

    Yes, the Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 offers Disease Management Program for Heart disease.

    Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs for Depression?

    Yes, the Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 offers Disease Management Program for Depression.

    Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs for Diabetes?

    Yes, the Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 offers Disease Management Program for Diabetes.

    Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs for Low back pain?

    Yes, the Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 offers Disease Management Program for Low back pain.

    Does Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan, Variant (17933TX0010001-02) offer Disease Management Programs for Pregnancy?

    Yes, the Moda Select Gold 1000 ($0 Virtual Urgent Care through CirrusMD) - AI/AN Zero Health Insurance Plan Variant 17933TX0010001-02 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 01 Jul 2025 05:26 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