Paramount Gold 3 - 74313OH0210015 Health Insurance Plan
Paramount Insurance Company health insurance plan with the Plan ID 74313OH0210015. The plan is called Paramount Gold 3.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 77.86% (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 22.14% 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 | 74313OH0210015 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Ohio | ||||||||||||||||||
| Health Insurance Issuer | Paramount Insurance Company | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 74313OH0210015-00 | ||||||||||||||||||
| Provider Network(s) | ['OHN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | Standard Off Exchange Plan - 74313OH0210015-00 Standard On Exchange Plan - 74313OH0210015-01 |
||||||||||||||||||
| Last Plan Update Date | Wed, 18 Aug 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Paramount Gold 3 Health Insurance Plan Variant 74313OH0210015-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.778608908 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2022 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold Off Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma,Heart Disease,Depression,Diabetes,Pregnancy |
| EHB Percent of Total Premium | 0.9974 |
| First Tier Utilization | 100% |
| Formulary ID | OHF001 |
| Formulary URL | URL |
| HIOS Product ID | 74313OH021 |
| Import Date | 8/18/2021 20:00 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 74313 |
| Issuer Marketplace Marketing Name | Paramount |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | OHN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 74313OH0210015-00 |
| Plan Marketing Name | Paramount Gold 3 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Paramount Gold 3 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,500 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $2,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $700 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $40 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $60 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | OHS002 |
| Source Name | SERFF |
| Plan ID | 74313OH0210015 |
| State Code | OH |
| 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 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $5000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $2500 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,500 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person 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 Per Group | $13000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $6500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $6,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Paramount Gold 3 Health Insurance Plan, 74313OH0210015
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Paramount Gold 3, 74313OH0210015 Health Insurance Plan, 74313OH0210015
-
Does Paramount Gold 3 Health Insurance Plan, 74313OH0210015 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (74313OH0210015) Health Insurance Plan, Variant (74313OH0210015-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma,Heart Disease,Depression,Diabetes,Pregnancy
Does (74313OH0210015) Health Insurance Plan, Variant (74313OH0210015-00) have Out Of Country Coverage?
Yes. Details: Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.
Does (74313OH0210015) Health Insurance Plan, Variant (74313OH0210015-00) have Out of Service Area Coverage?
Yes. Details: Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.
Does (74313OH0210015) Health Insurance Plan, Variant (74313OH0210015-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma,Heart Disease,Depression,Diabetes,Pregnancy
Does Paramount Gold 3 Health Insurance Plan, Variant (74313OH0210015-00) offer Disease Management Programs for Asthma?
Yes, the Paramount Gold 3 Health Insurance Plan Variant
74313OH0210015-00 offers Disease
Management Program for Asthma.
Does Paramount Gold 3 Health Insurance Plan, Variant (74313OH0210015-00) offer Disease Management Programs for Heart disease?
Yes, the Paramount Gold 3 Health Insurance Plan Variant
74313OH0210015-00 offers Disease
Management Program for Heart disease.
Does Paramount Gold 3 Health Insurance Plan, Variant (74313OH0210015-00) offer Disease Management Programs for Depression?
Yes, the Paramount Gold 3 Health Insurance Plan Variant
74313OH0210015-00 offers Disease
Management Program for Depression.
Does Paramount Gold 3 Health Insurance Plan, Variant (74313OH0210015-00) offer Disease Management Programs for Diabetes?
Yes, the Paramount Gold 3 Health Insurance Plan Variant
74313OH0210015-00 offers Disease
Management Program for Diabetes.
Does Paramount Gold 3 Health Insurance Plan, Variant (74313OH0210015-00) offer Disease Management Programs for Pregnancy?
Yes, the Paramount Gold 3 Health Insurance Plan Variant
74313OH0210015-00 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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