Health Options, Inc. health insurance plan with the Plan ID 30252FL0070070. The plan is called myBlue Connected Care Silver 24M03-70 ($0 Virtual PCP Visits / $0 Primary Care Visits with Select Providers / 24x7 Provider Access / Rewards).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 73.97% (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 26.03% 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 | 30252FL0070070 | ||||||||||||||||||
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Health Insurance Plan Year | 2025 | ||||||||||||||||||
State | Florida | ||||||||||||||||||
Health Insurance Issuer | Health Options, Inc. | ||||||||||||||||||
Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 30252FL0070070-04 | ||||||||||||||||||
Provider Network(s) | PREFERRED | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT). |
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Available Variants of the Health Plan | Standard Off Exchange Plan - 30252FL0070070-00 Standard On Exchange Plan - 30252FL0070070-01 Open to Indians below 300% FPL - 30252FL0070070-02 Open to Indians above 300% FPL - 30252FL0070070-03 73% AV Silver Plan - 30252FL0070070-04 |
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Last Plan Update Date | Thu, 19 Sep 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 13 May 2025 06:05 GMT |
Plan Attribute | Value |
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AV Calculator Output Number | 0.739719309449722 |
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 | 73% AV Level Silver Plan |
Dental Only Plan | No |
Design Type | Not Applicable |
Disease Management Programs Offered | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy |
EHB Percent of Total Premium | 1.0 |
First Tier Utilization | 46% |
Formulary ID | FLF019 |
Formulary URL | URL |
HIOS Product ID | 30252FL007 |
Import Date | 2024-09-19 01:01:32 |
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? | Yes |
Issuer ID | 30252 |
Issuer Marketplace Marketing Name | Florida Blue HMO (a BlueCross BlueShield FL company) |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | Yes |
Medical Drug Maximum Out of Pocket Integrated | Yes |
Metal Level | Silver |
Multiple In Network Tiers | Yes |
National Network | No |
Network ID | FLN002 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Accident and emergency services. |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Accident and emergency services. |
Plan Brochure | URL |
Plan Effective Date | 2025-01-01 |
Plan Expiration Date | 2025-12-31 |
Plan ID (Standard Component ID with Variant) | 30252FL0070070-04 |
Plan Marketing Name | myBlue Connected Care Silver 24M03-70 ($0 Virtual PCP Visits / $0 Primary Care Visits with Select Providers / 24x7 Provider Access / Rewards) |
Plan Type | HMO |
Plan Variant Marketing Name | myBlue Connected Care Silver 24M03-70A ($0 Virtual PCP Visits / $0 Primary Care and Specialist Visits with Select Providers / Rewards) |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $0 |
SBC Scenario, Having a Baby, Copayment | $200 |
SBC Scenario, Having a Baby, Deductible | $7,100 |
SBC Scenario, Having a Baby, Limit | $60 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $1,100 |
SBC Scenario, Having Diabetes, Deductible | $3,600 |
SBC Scenario, Having Diabetes, Limit | $0 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $400 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,200 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Second Tier Utilization | 54% |
Service Area ID | FLS005 |
Source Name | HIOS |
Specialist Requiring a Referral | All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists, Obstetric/Gynecologists, Behavioral Health Services, Physical Therapy, Occupational Therapy, and Speech Therapy. |
Plan ID | 30252FL0070070 |
State Code | FL |
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 | 50.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $14650 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $7325 per person |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,325 |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $14650 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $7325 per person |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $7,325 |
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 | $14700 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7350 per person |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,350 |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $14700 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $7350 per person |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $7,350 |
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 |
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, 13 May 2025 06:05 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