Personal Choice PPO Gold Classic - 31609PA0070011 Health Insurance Plan
QCC Insurance Company, Inc. health insurance plan with the Plan ID 31609PA0070011. The plan is called Personal Choice PPO Gold Classic.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.32% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.68% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 31609PA0070011 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | QCC Insurance Company, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 31609PA0070011-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN001'] | ||||||||||||||||||
| 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 | Standard On Exchange Plan - 31609PA0070011-01 |
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| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Personal Choice PPO Gold Classic Health Insurance Plan Variant 31609PA0070011-01 Attributes
| Plan Attribute | Value |
|---|---|
| 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 | 50.00% |
| 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, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | PAF003 |
| HIOS Product ID | 31609PA007 |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 78.32% |
| Issuer ID | 31609 |
| 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 | $1250 per person | $2500 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $1,250 |
| Medical EHB Deductible, Out of Network, Family | $6000 per person | $12000 per group |
| Medical EHB Deductible, Out of Network, Individual | $6,000 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | PAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Coverage is provided for benefits received while outside of the U.S. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage is provided for benefits received anywhere in the U.S. |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 31609PA0070011-01 |
| Plan Level Exclusions | Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs |
| Plan Marketing Name | Personal Choice PPO Gold Classic |
| Plan Type | PPO |
| Plan Variant Marketing Name | Personal Choice PPO Gold Classic |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $2,100 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $1,250 |
| SBC Scenario, Having a Baby, Limit | $20 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $2,500 |
| SBC Scenario, Having Diabetes, Deductible | $500 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $60 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,250 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | PAS001 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $1,000 |
| Plan ID | 31609PA0070011 |
| State Code | PA |
| 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 | $9100 per person | $18200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,100 |
| 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 | No |
Copay & Coinsurance of Personal Choice PPO Gold Classic Health Insurance Plan, 31609PA0070011
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Personal Choice PPO Gold Classic, 31609PA0070011 Health Insurance Plan, 31609PA0070011
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Does Personal Choice PPO Gold Classic Health Insurance Plan, 31609PA0070011 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (31609PA0070011) Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol
Does (31609PA0070011) Health Insurance Plan, Variant (31609PA0070011-01) have Out Of Country Coverage?
Yes. Details: Coverage is provided for benefits received while outside of the U.S.
Does (31609PA0070011) Health Insurance Plan, Variant (31609PA0070011-01) have Out of Service Area Coverage?
Yes. Details: Coverage is provided for benefits received anywhere in the U.S.
Does (31609PA0070011) Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol
Does Personal Choice PPO Gold Classic Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs for Asthma?
Yes, the Personal Choice PPO Gold Classic Health Insurance Plan Variant
31609PA0070011-01 offers Disease
Management Program for Asthma.
Does Personal Choice PPO Gold Classic Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs for Heart disease?
Yes, the Personal Choice PPO Gold Classic Health Insurance Plan Variant
31609PA0070011-01 offers Disease
Management Program for Heart disease.
Does Personal Choice PPO Gold Classic Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs for Depression?
Yes, the Personal Choice PPO Gold Classic Health Insurance Plan Variant
31609PA0070011-01 offers Disease
Management Program for Depression.
Does Personal Choice PPO Gold Classic Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs for Diabetes?
Yes, the Personal Choice PPO Gold Classic Health Insurance Plan Variant
31609PA0070011-01 offers Disease
Management Program for Diabetes.
Does Personal Choice PPO Gold Classic Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Personal Choice PPO Gold Classic Health Insurance Plan Variant
31609PA0070011-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Personal Choice PPO Gold Classic Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs for Low back pain?
Yes, the Personal Choice PPO Gold Classic Health Insurance Plan Variant
31609PA0070011-01 offers Disease
Management Program for Low back pain.
Does Personal Choice PPO Gold Classic Health Insurance Plan, Variant (31609PA0070011-01) offer Disease Management Programs for Pregnancy?
Yes, the Personal Choice PPO Gold Classic Health Insurance Plan Variant
31609PA0070011-01 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