Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP - 74289NY2780090 Health Insurance Plan
Oscar Insurance Corporation health insurance plan with the Plan ID 74289NY2780090. The plan is called Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 91.54% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 8.46% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 74289NY2780090 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New York | ||||||||||||||||||
| Health Insurance Issuer | Oscar Insurance Corporation | ||||||||||||||||||
| Health Insurance Plan Variant | 74289NY2780090-01 | ||||||||||||||||||
| Provider Network(s) | ['NYN002'] | ||||||||||||||||||
| 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 |
Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant 74289NY2780090-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol |
| First Tier Utilization | 100% |
| Formulary ID | NYF002 |
| HIOS Product ID | 74289NY278 |
| 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? | No |
| Issuer Actuarial Value | 91.54% |
| Issuer ID | 74289 |
| 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 | No |
| National Network | No |
| Network ID | NYN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services only. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency and Urgent Services only. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 74289NY2780090-01 |
| Plan Marketing Name | Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP |
| Plan Type | EPO |
| Plan Variant Marketing Name | Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $700 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $400 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $50 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NYS001 |
| Source Name | SERFF |
| Plan ID | 74289NY2780090 |
| State Code | NY |
| 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 | $0 per person | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 | $2800 per person | $5600 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $2,800 |
| 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 | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, 74289NY2780090
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP, 74289NY2780090 Health Insurance Plan, 74289NY2780090
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Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, 74289NY2780090 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (74289NY2780090) Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does (74289NY2780090) Health Insurance Plan, Variant (74289NY2780090-01) have Out Of Country Coverage?
Yes. Details: Emergency Services only.
Does (74289NY2780090) Health Insurance Plan, Variant (74289NY2780090-01) have Out of Service Area Coverage?
Yes. Details: Emergency and Urgent Services only.
Does (74289NY2780090) Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for Asthma?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for Asthma.
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for Heart disease?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for Heart disease.
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for Depression?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for Depression.
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for Diabetes?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for Diabetes.
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for Low back pain?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for Low back pain.
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for Pregnancy?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for Pregnancy.
Does Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan, Variant (74289NY2780090-01) offer Disease Management Programs for Weight loss programs?
Yes, the Platinum $0 Option 2, INN, Circle, Dep 29, Pediatric Dental, DP, FP Health Insurance Plan Variant
74289NY2780090-01 offers Disease
Management Program for Weight loss programs.
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