Arkansas health plan · 2025

Octave Silver AH · 48772AR0010003

USAble HMO, Inc. d/b/a Octave offers this marketplace health insurance plan (Plan ID 48772AR0010003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: POS CSR: Standard Silver Off Exchange Plan Issuer: USAble HMO, Inc. d/b/a Octave
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 70.26% (29.74% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$299 – $1174

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$5,950

$11900 per group

Review MOOP rules

Office visits

Primary care $30.00 Copay after deductible
Specialist $45.00 Copay after deductible
HSA Not eligible

Drug tiers

Generic $100.00
Preferred brand $1,000.00

View formulary tiers

$410 / mo before subsidies

≈ $4923 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1300 / mo before subsidies

≈ $15599 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1574 / mo before subsidies

≈ $18892 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1000 / mo before subsidies

≈ $12006 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

$800.00 Copay after deductible

Durable Medical Equipment

$250.00 Copay after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Arkansas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Silver Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

$800.00 Copay after deductible

Durable Medical Equipment

$250.00 Copay after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 48772AR0010003
Coverage year 2025
State Arkansas
Issuer USAble HMO, Inc. d/b/a Octave
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 48772AR0010003-00
Available variants

Standard Off Exchange Plan · 48772AR0010003-00

Standard On Exchange Plan · 48772AR0010003-01

Open to Indians below 300% FPL · 48772AR0010003-02

Open to Indians above 300% FPL · 48772AR0010003-03

73% AV Silver Plan · 48772AR0010003-04

87% AV Silver Plan · 48772AR0010003-05

94% AV Silver Plan · 48772AR0010003-06
Last plan update Thu, 10 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Arkansas N/A
PCPs in Arkansas N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Arkansas All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,724 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,661
PREFERRED-SPECIALTY 454
PREFERRED-BRAND 304
NONPREFERRED-BRAND 223
NONPREFERRED-SPECIALTY 82
Prior authorization Drugs
Required 872
Not Required 2,852
Step therapy Drugs
Required 226
Not Required 3,498
Quantity limits Drugs
Has Limit 1,087
No Limit 2,637

Customer highlights

What stands out for members

  • Issuer: USAble HMO, Inc. d/b/a Octave · Plan ID 48772AR0010003 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 48772AR0010003-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.

Exclusions: nan

Diabetes Care Management

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Diabetes Education

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Home Health Care Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 50.0 Visit(s) per Year

Coverage is provided for Home Health Services when Coverage Policy supports the need for in-home service and such care is prescribed or ordered by a Physician. Covered Services must be provided through and billed by a licensed home health agency. Covered Services provided in the home include services of a Registered Professional Nurse (R.N.), a Licensed Practical Nurse (L.P.N.) or a Licensed Psychiatric Technical Nurse (L.P.T.N.).

Exclusions: nan

Laboratory Outpatient and Professional Services

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Preventive Drugs

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.

Exclusions: nan

Rehabilitative Speech Therapy

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.

Exclusions: nan

Specialist Visit

$45.00 Copay after deductible
Tier 1 in-network $45.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Urgent Care Centers or Facilities

$45.00 Copay after deductible
Tier 1 in-network $45.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Childbirth/delivery professional services: 48772AR001003-01-30% Coinsurance after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 48772AR001003-02-No charge for in-network and out-of-network services; 48772AR001003-03-30% Coinsurance after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 48772AR0010003-04-No charge after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 48772AR0010003-05-No charge after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; 48772AR0010003-06-No charge after deductible for in-network services and 50% Coinsurance after deductible for out-of-network services; Coverage for Out of Network newborn services is limited to $2000 per person for all services first 90 days after birth. Coverage requires Prior Notification to Octave.

Exclusions: nan

Dialysis

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Durable Medical Equipment

$250.00 Copay after deductible
Tier 1 in-network $250.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Room Services

$800.00 Copay after deductible
Tier 1 in-network $800.00 Copay after deductible
Out-of-network $800.00 Copay after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 30.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

If the Covered Person has been diagnosed and certified by the attending Physician as having a terminal illness with a life expectancy of six months or less, Octave will pay the Allowance or Allowable Charge for Hospice Care. The services must be rendered by an entity licensed by the Arkansas Department of Health or other appropriate state licensing agency and accepted by Octave as a Provider. This benefit is subject to the Deductible, Copayment and Coinsurance specified in the Schedule of Benefits.

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$800.00 Copay per Day after deductible
Tier 1 in-network $800.00 Copay per Day after deductible
Out-of-network 50.00% Coinsurance after deductible

Requires prior notification to Octave.

Exclusions: nan

Inpatient Physician and Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$800.00 Copay per Day after deductible
Tier 1 in-network $800.00 Copay per Day after deductible
Out-of-network 50.00% Coinsurance after deductible

Requires prior notification to Octave.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

Cost Sharing does NOT apply to screenings.The cost sharing that displays applies to outpatient evaluation, consultation, and psychotherapy office visits only. All other outpatient services and procedures provided in an office or outpatient facility may be subject to additional cost sharing. Please refer to plan policy documents for detailed information.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$45.00 Copay after deductible
Tier 1 in-network $45.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Outpatient Rehabilitation Services

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$45.00 Copay after deductible
Tier 1 in-network $45.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Radiation

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Skilled Nursing Facility

$800.00 Copay per Day after deductible
Tier 1 in-network $800.00 Copay per Day after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 60.0 Days per Year

1. The admission must be within seven days of release from an inpatient Hospital stay; 2. The Skilled Nursing Facility services are of a temporary nature and increase ability to function.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$800.00 Copay per Day after deductible
Tier 1 in-network $800.00 Copay per Day after deductible
Out-of-network 50.00% Coinsurance after deductible

Requires prior notification to Octave.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Transplant

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

80.00%
Tier 1 in-network 80.00%
Out-of-network 80.00%

Coverage is limited to $1400/hearing aid

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Requires Prior Notification to Octave. Coverage for routine ultrasound is limited to 1.

Exclusions: nan

Routine Eye Exam for Children

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$100.00
Tier 1 in-network $100.00
Out-of-network 100.00%

Mail Order cost: 48772AR001003-01- $200 Copay in-network, 48772AR001003-03- $200 Copay in-network, 48772AR001003-04- $200 Copay in-network, 48772AR001003-05- $10 Copay in-network, and 48772AR001003-06- $9.40 Copay in-network.

Exclusions: nan

Non-Preferred Brand Drugs

$2,000.00
Tier 1 in-network $2,000.00
Out-of-network 100.00%

Mail Order cost: 48772AR001003-01- $4000 Copay in-network, 48772AR001003-03- $4000 Copay in-network, 48772AR001003-04- $4000 Copay in-network, 48772AR001003-05- $200 Copay in-network, and 48772AR001003-06- $18.80 Copay in-network.

Exclusions: nan

Off Label Prescription Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Preferred Brand Drugs

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network 100.00%

Mail Order cost: 48772AR001003-01- $2000 Copay in-network, 48772AR001003-03- $2000 Copay in-network, 48772AR001003-04- $2000 Copay in-network, 48772AR001003-05- $50 Copay in-network, and 48772AR001003-06- $9.40 Copay in-network.

Exclusions: nan

Specialty Drugs

$5,950.00
Tier 1 in-network $5,950.00
Out-of-network 100.00%

Requires Prior Approval from Octave.

Exclusions: nan

Specialty Drugs Tier 2

$5,950.00
Tier 1 in-network $5,950.00
Out-of-network 100.00%

Requires Prior Approval from Octave.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Anesthesia

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Home infusion therapy.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Coverage is provided for dietary and nutritional counseling services when provided in conjunction with diabetic self-management training, for services needed by covered persons in connection with cleft palate management and for nutritional assessment programs provided in and by a hospital and approved by Octave.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Replaced no more frequently than once per 3-yr period except when necessary for growth or end of device's useful life.

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

SOB includes 'allergy services.'

Exclusions: nan

Applied Behavior Analysis Based Therapies

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cochlear Implants

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

One cochlear implant per ear per Covered Person per lifetime

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Craniofacial Surgery

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Eye Glasses for Children

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Item(s) per Year

nan

Exclusions: nan

Gastric Electrical Stimulation

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Gender Affirming Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Habilitation Services

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limit is explicitly a combined 30-visit limit for PT, OT, ST and chiro; Limited to a maximum of 180 units for developmental services visits per Covered Person per calendar year.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Inherited Metabolic Disorder - PKU

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

1. Treatment provided for the correction of defects incurred in an Accidental Injury sustained by the Covered Person; 2. Surgery performed for the removal of a port-wine stain or hemangioma (only on the face) 3. Treatment provided for reconstructive surgery following neoplastic (cancer) surgery; 4. In connection with a mastectomy resulting from surgery, services for (a) reconstruction of the breast on which the cancer-related surgery was performed; (b) surgery to reconstruct the other breast to produce a symmetrical appearance; and (c) prostheses and services to correct physical complications for all stages of the mastectomy, including lymphedemas; 5. Reduction mammoplasty, if such reduction mammoplasty meets Coverage Criteria.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Well Child Care

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Variant attributes

Octave Silver AH · Variant 48772AR0010003-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

48772AR001

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

48772AR0010003-00

Plan Marketing Name

Octave Silver AH

Plan Variant Marketing Name

Octave Silver AH

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

48772

Issuer Marketplace Marketing Name

Octave

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

ARN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency Care

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Benefit Reduction

Service Area ID

ARS001

State Code

AR

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.702647985512467

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

30.00%

SBC Scenario, Having a Baby, Coinsurance

$2,100

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$5,600

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$400

SBC Scenario, Having Diabetes, Deductible

$5,600

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,900

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

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$11900 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$5950 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$5,950

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$19000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$9500 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$9,500

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ARF001

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$40

SBC Scenario, Having Diabetes, Limit

$60

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, Out of Network, Family Per Group

$0 per group

Drug EHB Deductible, Out of Network, Family Per Person

$0 per person

Drug EHB Deductible, Out of Network, Individual

$0

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

0.9996

First Tier Utilization

100%

Import Date

2024-10-10 20:01:47

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$11100 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$5550 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$5,550

Medical EHB Deductible, Out of Network, Family Per Group

$16600 per group

Medical EHB Deductible, Out of Network, Family Per Person

$8300 per person

Medical EHB Deductible, Out of Network, Individual

$8,300

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Level Exclusions

No

Plan Type

POS

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

48772AR0010003

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Arkansas?

Octave Silver AH (48772AR0010003) is a Silver POS from USAble HMO, Inc. d/b/a Octave in Arkansas for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Octave Silver AH support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Octave Silver AH HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Octave Silver AH support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Octave Silver AH?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for Octave Silver AH?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Care

Does Octave Silver AH cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Benefit Reduction

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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