PacificSource Cascade Gold - 14057WA0060009 Health Insurance Plan
PacificSource Health Plans health insurance plan with the Plan ID 14057WA0060009. The plan is called PacificSource Cascade Gold.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.88% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.12% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 82.61% (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 17.39% 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 | 14057WA0060009 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Washington | ||||||||||||||||||
| Health Insurance Issuer | PacificSource Health Plans | ||||||||||||||||||
| Health Insurance Plan Variant | 14057WA0060009-01 | ||||||||||||||||||
| Provider Network(s) | ['WAN005'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | Standard On Exchange Plan - 14057WA0060009-01 |
||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
PacificSource Cascade Gold Health Insurance Plan Variant 14057WA0060009-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.826059553 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family | $0 per person | $0 per group |
| Drug EHB Deductible, Out of Network, Individual | $0 |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, Pregnancy |
| EHB Percent of Total Premium | 99.86% |
| First Tier Utilization | 100% |
| Formulary ID | WAF007 |
| HIOS Product ID | 14057WA006 |
| 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 Actuarial Value | 81.88% |
| Issuer ID | 14057 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $600 per person | $1200 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $600 |
| Medical EHB Deductible, Out of Network, Family | $10000 per person | $20000 per group |
| Medical EHB Deductible, Out of Network, Individual | $10,000 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | WAN005 |
| 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 | Out-of-Network Providers |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 14057WA0060009-01 |
| Plan Marketing Name | PacificSource Cascade Gold |
| Plan Type | PPO |
| Plan Variant Marketing Name | PacificSource Cascade Gold |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,400 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $40 |
| SBC Scenario, Having Diabetes, Copayment | $1,200 |
| SBC Scenario, Having Diabetes, Deductible | $600 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $900 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | WAS004 |
| Source Name | SERFF |
| Plan ID | 14057WA0060009 |
| State Code | WA |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $5900 per person | $11800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $5,900 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $25000 per person | $50000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $25,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of PacificSource Cascade Gold Health Insurance Plan, 14057WA0060009
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about PacificSource Cascade Gold, 14057WA0060009 Health Insurance Plan, 14057WA0060009
-
Does PacificSource Cascade Gold Health Insurance Plan, 14057WA0060009 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (14057WA0060009) Health Insurance Plan, Variant (14057WA0060009-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does (14057WA0060009) Health Insurance Plan, Variant (14057WA0060009-01) have Out Of Country Coverage?
Yes. Details: Emergency Care Only
Does (14057WA0060009) Health Insurance Plan, Variant (14057WA0060009-01) have Out of Service Area Coverage?
Yes. Details: Out-of-Network Providers
Does (14057WA0060009) Health Insurance Plan, Variant (14057WA0060009-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does PacificSource Cascade Gold Health Insurance Plan, Variant (14057WA0060009-01) offer Disease Management Programs for Asthma?
Yes, the PacificSource Cascade Gold Health Insurance Plan Variant
14057WA0060009-01 offers Disease
Management Program for Asthma.
Does PacificSource Cascade Gold Health Insurance Plan, Variant (14057WA0060009-01) offer Disease Management Programs for Heart disease?
Yes, the PacificSource Cascade Gold Health Insurance Plan Variant
14057WA0060009-01 offers Disease
Management Program for Heart disease.
Does PacificSource Cascade Gold Health Insurance Plan, Variant (14057WA0060009-01) offer Disease Management Programs for Diabetes?
Yes, the PacificSource Cascade Gold Health Insurance Plan Variant
14057WA0060009-01 offers Disease
Management Program for Diabetes.
Does PacificSource Cascade Gold Health Insurance Plan, Variant (14057WA0060009-01) offer Disease Management Programs for Pregnancy?
Yes, the PacificSource Cascade Gold Health Insurance Plan Variant
14057WA0060009-01 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