Passage Gold POS PCP - 76962CT0020001 Health Insurance Plan
ConnectiCare Benefits Inc. health insurance plan with the Plan ID 76962CT0020001. The plan is called Passage Gold POS PCP.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.10% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.90% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 76962CT0020001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Connecticut | ||||||||||||||||||
| Health Insurance Issuer | ConnectiCare Benefits Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 76962CT0020001-01 | ||||||||||||||||||
| Provider Network(s) | ['CTN002'] | ||||||||||||||||||
| 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, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Passage Gold POS PCP Health Insurance Plan Variant 76962CT0020001-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol |
| First Tier Utilization | 100% |
| Formulary ID | CTF001 |
| HIOS Product ID | 76962CT002 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 78.10% |
| Issuer ID | 76962 |
| Market Coverage | SHOP (Small Group) |
| 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 | CTN002 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 76962CT0020001-01 |
| Plan Marketing Name | Passage Gold POS PCP |
| Plan Type | POS |
| Plan Variant Marketing Name | Passage Gold POS PCP |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,200 |
| SBC Scenario, Having a Baby, Copayment | $200 |
| SBC Scenario, Having a Baby, Deductible | $3,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $400 |
| SBC Scenario, Having Diabetes, Copayment | $900 |
| 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 | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | CTS002 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All Specialists excluding OB/GYN |
| Specialty Drug Maximum Coinsurance | $500 |
| Plan ID | 76962CT0020001 |
| State Code | CT |
| 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $3000 per person | $6000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,000 |
| TEHBDedOutofNetFamily | $20000 per person | $40000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $20,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $8500 per person | $17000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $30000 per person | $60000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $30,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Passage Gold POS PCP Health Insurance Plan, 76962CT0020001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Passage Gold POS PCP, 76962CT0020001 Health Insurance Plan, 76962CT0020001
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Does Passage Gold POS PCP Health Insurance Plan, 76962CT0020001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (76962CT0020001) Health Insurance Plan, Variant (76962CT0020001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol
Does (76962CT0020001) Health Insurance Plan, Variant (76962CT0020001-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (76962CT0020001) Health Insurance Plan, Variant (76962CT0020001-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan).
Does (76962CT0020001) Health Insurance Plan, Variant (76962CT0020001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol
Does Passage Gold POS PCP Health Insurance Plan, Variant (76962CT0020001-01) offer Disease Management Programs for Asthma?
Yes, the Passage Gold POS PCP Health Insurance Plan Variant
76962CT0020001-01 offers Disease
Management Program for Asthma.
Does Passage Gold POS PCP Health Insurance Plan, Variant (76962CT0020001-01) offer Disease Management Programs for Heart disease?
Yes, the Passage Gold POS PCP Health Insurance Plan Variant
76962CT0020001-01 offers Disease
Management Program for Heart disease.
Does Passage Gold POS PCP Health Insurance Plan, Variant (76962CT0020001-01) offer Disease Management Programs for Diabetes?
Yes, the Passage Gold POS PCP Health Insurance Plan Variant
76962CT0020001-01 offers Disease
Management Program for Diabetes.
Does Passage Gold POS PCP Health Insurance Plan, Variant (76962CT0020001-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Passage Gold POS PCP Health Insurance Plan Variant
76962CT0020001-01 offers Disease
Management Program for High blood pressure & high cholesterol.
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