OMNIA Platinum - 91661NJ2350005 Health Insurance Plan

Horizon Healthcare Services, Inc. health insurance plan with the Plan ID 91661NJ2350005. The plan is called OMNIA Platinum.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 91.74% (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 8.26% 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 91661NJ2350005
Health Insurance Plan Year 2023
State New Jersey
Health Insurance Issuer Horizon Healthcare Services, Inc.
Health Insurance Plan Variant 91661NJ2350005-01
Provider Network(s) ['NJN004']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT).

Providers New Jersey 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
Available Variants of the Health Plan

Standard On Exchange Plan - 91661NJ2350005-01

Last Plan Update Date Mon, 23 Jan 2023 00:00 GMT
Last Import Date Tue, 07 May 2024 06:08 GMT

OMNIA Platinum Health Insurance Plan Variant 91661NJ2350005-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.917352202
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
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, Pregnancy
First Tier Utilization 80.10
Formulary ID NJF009
HIOS Product ID 91661NJ235
HSA/HRA Employer Contribution No
Import Date 1/23/2023
Inpatient Copayment Maximum Days 5
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 91661
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 Yes
National Network No
Network ID NJN004
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Only to true medical emergencies and accidental injuries.
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 91661NJ2350005-01
Plan Marketing Name OMNIA Platinum
Plan Type EPO
Plan Variant Marketing Name OMNIA Platinum
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $300
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $500
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $100
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 19.90
Service Area ID NJS002
Source Name SERFF
Plan ID 91661NJ2350005
State Code NJ
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 per person not applicable | $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family $1000 per person | $2000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $1,000
TEHBDedOutofNetFamily per person not applicable | per group 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 $2600 per person | $5200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $2,600
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family $3650 per person | $7300 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $3,650
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family per person not applicable | per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design No
Version Number 1
Wellness Program Offered No

Copay & Coinsurance of OMNIA Platinum Health Insurance Plan, 91661NJ2350005

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

Frequently Asked Questions(FAQ) about OMNIA Platinum, 91661NJ2350005 Health Insurance Plan, 91661NJ2350005

  • Does OMNIA Platinum Health Insurance Plan, 91661NJ2350005 support Mail Ordering?

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

  • Does (91661NJ2350005) Health Insurance Plan, Variant (91661NJ2350005-01) offer Disease Management Programs?

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

    Does (91661NJ2350005) Health Insurance Plan, Variant (91661NJ2350005-01) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (91661NJ2350005) Health Insurance Plan, Variant (91661NJ2350005-01) have Out of Service Area Coverage?

    Yes. Details: Only to true medical emergencies and accidental injuries.

    Does (91661NJ2350005) Health Insurance Plan, Variant (91661NJ2350005-01) offer Disease Management Programs?

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

    Does OMNIA Platinum Health Insurance Plan, Variant (91661NJ2350005-01) offer Disease Management Programs for Asthma?

    Yes, the OMNIA Platinum Health Insurance Plan Variant 91661NJ2350005-01 offers Disease Management Program for Asthma.

    Does OMNIA Platinum Health Insurance Plan, Variant (91661NJ2350005-01) offer Disease Management Programs for Heart disease?

    Yes, the OMNIA Platinum Health Insurance Plan Variant 91661NJ2350005-01 offers Disease Management Program for Heart disease.

    Does OMNIA Platinum Health Insurance Plan, Variant (91661NJ2350005-01) offer Disease Management Programs for Depression?

    Yes, the OMNIA Platinum Health Insurance Plan Variant 91661NJ2350005-01 offers Disease Management Program for Depression.

    Does OMNIA Platinum Health Insurance Plan, Variant (91661NJ2350005-01) offer Disease Management Programs for Diabetes?

    Yes, the OMNIA Platinum Health Insurance Plan Variant 91661NJ2350005-01 offers Disease Management Program for Diabetes.

    Does OMNIA Platinum Health Insurance Plan, Variant (91661NJ2350005-01) offer Disease Management Programs for Pregnancy?

    Yes, the OMNIA Platinum Health Insurance Plan Variant 91661NJ2350005-01 offers Disease Management Program for Pregnancy.

 

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