Navigator Bronze 7000 Exchange - 10091OR0750020 Health Insurance Plan

PacificSource Health Plans health insurance plan with the Plan ID 10091OR0750020. The plan is called Navigator Bronze 7000 Exchange.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 61.97% (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 38.03% 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 10091OR0750020
Health Insurance Plan Year 2025
State Oregon
Health Insurance Issuer PacificSource Health Plans
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 10091OR0750020-00
Provider Network(s) TIER-ONE
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT).

Providers Oregon All US States
All 1038 2038
PCP 79 113
Allergy N/A N/A
OB/GYN 5 6
Dentists 539 1084
Available Variants of the Health Plan

Standard Off Exchange Plan - 10091OR0750020-00

Standard On Exchange Plan - 10091OR0750020-01

Open to Indians below 300% FPL - 10091OR0750020-02

Open to Indians above 300% FPL - 10091OR0750020-03

Last Plan Update Date Thu, 01 Aug 2024 00:00 GMT
Last Import Date Tue, 13 May 2025 06:05 GMT

Navigator Bronze 7000 Exchange Health Insurance Plan Variant 10091OR0750020-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.6196533043080401
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 Standard Bronze Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Diabetes, Heart Disease, Pregnancy
EHB Percent of Total Premium 0.9999
First Tier Utilization 100%
Formulary ID ORF003
Formulary URL URL
HIOS Product ID 10091OR075
Import Date 2024-08-01 20:01:31
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 10091
Issuer Marketplace Marketing Name PacificSource Health Plans
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 ORN005
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 In and out-of-network providers
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 10091OR0750020-00
Plan Marketing Name Navigator Bronze 7000 Exchange
Plan Type PPO
Plan Variant Marketing Name Navigator Bronze 7000 Exchange
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,200
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $7,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,200
SBC Scenario, Having Diabetes, Deductible $1,300
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 $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ORS002
Source Name SERFF
Plan ID 10091OR0750020
State Code OR
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 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $14000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $7000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $7,000
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $20000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $10000 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $10,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,200
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $50000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $25000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $25,000
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Navigator Bronze 7000 Exchange Health Insurance Plan, 10091OR0750020

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

Frequently Asked Questions(FAQ) about Navigator Bronze 7000 Exchange, 10091OR0750020 Health Insurance Plan, 10091OR0750020

  • Does Navigator Bronze 7000 Exchange Health Insurance Plan, 10091OR0750020 support Mail Ordering?

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

  • Does (10091OR0750020) Health Insurance Plan, Variant (10091OR0750020-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, Pregnancy

    Does (10091OR0750020) Health Insurance Plan, Variant (10091OR0750020-00) have Out Of Country Coverage?

    Yes. Details: Emergency Care Only

    Does (10091OR0750020) Health Insurance Plan, Variant (10091OR0750020-00) have Out of Service Area Coverage?

    Yes. Details: In and out-of-network providers

    Does (10091OR0750020) Health Insurance Plan, Variant (10091OR0750020-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, Pregnancy

    Does Navigator Bronze 7000 Exchange Health Insurance Plan, Variant (10091OR0750020-00) offer Disease Management Programs for Asthma?

    Yes, the Navigator Bronze 7000 Exchange Health Insurance Plan Variant 10091OR0750020-00 offers Disease Management Program for Asthma.

    Does Navigator Bronze 7000 Exchange Health Insurance Plan, Variant (10091OR0750020-00) offer Disease Management Programs for Heart disease?

    Yes, the Navigator Bronze 7000 Exchange Health Insurance Plan Variant 10091OR0750020-00 offers Disease Management Program for Heart disease.

    Does Navigator Bronze 7000 Exchange Health Insurance Plan, Variant (10091OR0750020-00) offer Disease Management Programs for Diabetes?

    Yes, the Navigator Bronze 7000 Exchange Health Insurance Plan Variant 10091OR0750020-00 offers Disease Management Program for Diabetes.

    Does Navigator Bronze 7000 Exchange Health Insurance Plan, Variant (10091OR0750020-00) offer Disease Management Programs for Pregnancy?

    Yes, the Navigator Bronze 7000 Exchange Health Insurance Plan Variant 10091OR0750020-00 offers Disease Management Program for Pregnancy.

 

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