Non-Standard Silver: PPO HSA 2000 - Flex - 36046MA0810055 Health Insurance Plan
Harvard Pilgrim Healthcare, Inc. health insurance plan with the Plan ID 36046MA0810055. The plan is called Non-Standard Silver: PPO HSA 2000 - Flex.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.70% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.30% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 36046MA0810055 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Massachusetts | ||||||||||||||||||
| Health Insurance Issuer | Harvard Pilgrim Healthcare, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 36046MA0810055-01 | ||||||||||||||||||
| Provider Network(s) | ['MAN003'] | ||||||||||||||||||
| 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, 22 May 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant 36046MA0810055-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver 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 | MAF006 |
| HIOS Product ID | 36046MA081 |
| HSA/HRA Employer Contribution | No |
| Import Date | 5/22/2023 |
| HSA Eligible | Yes |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 70.70% |
| Issuer ID | 36046 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | MAN003 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | All Covered Benefits except for Emergency Care are covered at the Out of Network Cost Sharing. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | All Covered Benefits except for Emergency Care are covered at the Out of Network Cost Sharing. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 36046MA0810055-01 |
| Plan Marketing Name | Non-Standard Silver: PPO HSA 2000 - Flex |
| Plan Type | PPO |
| Plan Variant Marketing Name | Non-Standard Silver: PPO HSA 2000 - Flex |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,200 |
| SBC Scenario, Having a Baby, Deductible | $2,000 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $300 |
| SBC Scenario, Having Diabetes, Deductible | $2,000 |
| 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 | $2,000 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MAS001 |
| Source Name | SERFF |
| Plan ID | 36046MA0810055 |
| State Code | MA |
| 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 | $2000 per person | $4000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| TEHBDedOutofNetFamily | $4000 per person | $8000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $4,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $7050 per person | $14100 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,050 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $14100 per person | $28200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $14,100 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, 36046MA0810055
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Non-Standard Silver: PPO HSA 2000 - Flex, 36046MA0810055 Health Insurance Plan, 36046MA0810055
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Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, 36046MA0810055 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (36046MA0810055) Health Insurance Plan, Variant (36046MA0810055-01) 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 (36046MA0810055) Health Insurance Plan, Variant (36046MA0810055-01) have Out Of Country Coverage?
Yes. Details: All Covered Benefits except for Emergency Care are covered at the Out of Network Cost Sharing.
Does (36046MA0810055) Health Insurance Plan, Variant (36046MA0810055-01) have Out of Service Area Coverage?
Yes. Details: All Covered Benefits except for Emergency Care are covered at the Out of Network Cost Sharing.
Does (36046MA0810055) Health Insurance Plan, Variant (36046MA0810055-01) 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 Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for Asthma?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 offers Disease
Management Program for Asthma.
Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for Heart disease?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 offers Disease
Management Program for Heart disease.
Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for Depression?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 offers Disease
Management Program for Depression.
Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for Diabetes?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 offers Disease
Management Program for Diabetes.
Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for Low back pain?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 offers Disease
Management Program for Low back pain.
Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for Pregnancy?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 offers Disease
Management Program for Pregnancy.
Does Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan, Variant (36046MA0810055-01) offer Disease Management Programs for Weight loss programs?
Yes, the Non-Standard Silver: PPO HSA 2000 - Flex Health Insurance Plan Variant
36046MA0810055-01 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