Neighborhood PRIME Elite - 77514RI0030002 Health Insurance Plan
Neighborhood Health Plan of Rhode Island health insurance plan with the Plan ID 77514RI0030002. The plan is called Neighborhood PRIME Elite.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 91.94% (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 8.06% 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 | 77514RI0030002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Rhode Island | ||||||||||||||||||
| Health Insurance Issuer | Neighborhood Health Plan of Rhode Island | ||||||||||||||||||
| Health Insurance Plan Variant | 77514RI0030002-01 | ||||||||||||||||||
| Provider Network(s) | ['RIN001'] | ||||||||||||||||||
| 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 |
Neighborhood PRIME Elite Health Insurance Plan Variant 77514RI0030002-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.91939544 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Platinum On Exchange Plan |
| Dental Only Plan | No |
| First Tier Utilization | 100% |
| Formulary ID | RIF001 |
| HIOS Product ID | 77514RI003 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 77514 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Platinum |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | RIN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of Services covered with separate out of nework deductible, out of pocket, and coinsurance. Services may require prior authorization |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 77514RI0030002-01 |
| Plan Marketing Name | Neighborhood PRIME Elite |
| Plan Type | POS |
| Plan Variant Marketing Name | Neighborhood PRIME Elite |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $800 |
| SBC Scenario, Having Diabetes, Deductible | $500 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| 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 | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | RIS001 |
| Source Name | SERFF |
| Plan ID | 77514RI0030002 |
| State Code | RI |
| 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 | $500 per person | $1000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $500 |
| TEHBDedOutofNetFamily | $5000 per person | $10000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $5,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $1500 per person | $3000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $1,500 |
| 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 | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Neighborhood PRIME Elite Health Insurance Plan, 77514RI0030002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Neighborhood PRIME Elite, 77514RI0030002 Health Insurance Plan, 77514RI0030002
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Does Neighborhood PRIME Elite Health Insurance Plan, 77514RI0030002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (77514RI0030002) Health Insurance Plan, Variant (77514RI0030002-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (77514RI0030002) Health Insurance Plan, Variant (77514RI0030002-01) have Out of Service Area Coverage?
Yes. Details: Out of Services covered with separate out of nework deductible, out of pocket, and coinsurance. Services may require prior authorization
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