Moda Select Gold 3000 - 80588ID0020005 Health Insurance Plan
Moda Health Plan, Inc health insurance plan with the Plan ID 80588ID0020005. The plan is called Moda Select Gold 3000.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.80% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.20% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 80588ID0020005 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | Moda Health Plan, Inc | ||||||||||||||||||
| Health Insurance Plan Variant | 80588ID0020005-01 | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Moda Select Gold 3000 Health Insurance Plan Variant 80588ID0020005-01 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 3 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | Yes |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol |
| First Tier Utilization | 100% |
| Formulary ID | IDF001 |
| HIOS Product ID | 80588ID002 |
| HSA/HRA Employer Contribution | No |
| 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 | 81.80% |
| Issuer ID | 80588 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| 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 | All covered services for out of service area employees and dependents and emergency care only for out of service area travel |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 80588ID0020005-01 |
| Plan Marketing Name | Moda Select Gold 3000 |
| Plan Type | POS |
| Plan Variant Marketing Name | Moda Select Gold 3000 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,600 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $3,000 |
| SBC Scenario, Having a Baby, Limit | $50 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $400 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $100 |
| 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 | 80588ID0020005 |
| 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $3000 per person | $6000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,000 |
| TEHBDedOutofNetFamily | $9000 per person | $18000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $9,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $5000 per person | $10000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $5,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $10000 per person | $20000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $10,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Moda Select Gold 3000 Health Insurance Plan, 80588ID0020005
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Moda Select Gold 3000, 80588ID0020005 Health Insurance Plan, 80588ID0020005
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Does Moda Select Gold 3000 Health Insurance Plan, 80588ID0020005 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (80588ID0020005) Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does (80588ID0020005) Health Insurance Plan, Variant (80588ID0020005-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (80588ID0020005) Health Insurance Plan, Variant (80588ID0020005-01) have Out of Service Area Coverage?
Yes. Details: All covered services for out of service area employees and dependents and emergency care only for out of service area travel
Does (80588ID0020005) Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for Asthma?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for Asthma.
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for Heart disease?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for Heart disease.
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for Depression?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for Depression.
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for Diabetes?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for Diabetes.
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for Low back pain?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for Low back pain.
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for Pregnancy?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for Pregnancy.
Does Moda Select Gold 3000 Health Insurance Plan, Variant (80588ID0020005-01) offer Disease Management Programs for Weight loss programs?
Yes, the Moda Select Gold 3000 Health Insurance Plan Variant
80588ID0020005-01 offers Disease
Management Program for Weight loss programs.
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