POS Bronze 7500 - 86584WI0020005 Health Insurance Plan

Aspirus Health Plan, Inc. health insurance plan with the Plan ID 86584WI0020005. The plan is called POS Bronze 7500.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.81% (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 36.19% 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 86584WI0020005
Health Insurance Plan Year 2025
State Wisconsin
Health Insurance Issuer Aspirus Health Plan, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 86584WI0020005-00
Provider Network(s) ASPIRUSSIGN
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT).

Providers Wisconsin All US States
All 12150 12979
PCP 2297 2473
Allergy 11 11
OB/GYN 109 121
Dentists 22 25
Available Variants of the Health Plan

Standard Off Exchange Plan - 86584WI0020005-00

Standard On Exchange Plan - 86584WI0020005-01

Open to Indians below 300% FPL - 86584WI0020005-02

Open to Indians above 300% FPL - 86584WI0020005-03

Last Plan Update Date Wed, 02 Oct 2024 00:00 GMT
Last Import Date Tue, 13 May 2025 06:05 GMT

POS Bronze 7500 Health Insurance Plan Variant 86584WI0020005-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.638091065338329
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze Off Exchange Plan
Dental Only Plan No
Design Type Design 1
Disease Management Programs Offered Diabetes, High Blood Pressure & High Cholesterol
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID WIF002
Formulary URL URL
HIOS Product ID 86584WI002
Import Date 2024-10-02 01:01:28
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 No
Is a Referral Required for Specialist? No
Issuer ID 86584
Issuer Marketplace Marketing Name Aspirus Health Plan
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID WIN001
Out of Country Coverage No
Out of Country Coverage Description Limited to emergency care only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Services paid at the non-participating provider level
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 86584WI0020005-00
Plan Marketing Name POS Bronze 7500
Plan Type POS
Plan Variant Marketing Name POS Bronze 7500
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,700
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $7,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,000
SBC Scenario, Having Diabetes, Deductible $900
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $500
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID WIS001
Source Name HIOS
Plan ID 86584WI0020005
State Code WI
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 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $15000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $7500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $7,500
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $30000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $15000 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $15,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,200
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $50000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $25000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $25,000
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of POS Bronze 7500 Health Insurance Plan, 86584WI0020005

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about POS Bronze 7500, 86584WI0020005 Health Insurance Plan, 86584WI0020005

  • Does POS Bronze 7500 Health Insurance Plan, 86584WI0020005 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (86584WI0020005) Health Insurance Plan, Variant (86584WI0020005-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes, High Blood Pressure & High Cholesterol

    Does (86584WI0020005) Health Insurance Plan, Variant (86584WI0020005-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan). Details: Limited to emergency care only

    Does (86584WI0020005) Health Insurance Plan, Variant (86584WI0020005-00) have Out of Service Area Coverage?

    Yes. Details: Services paid at the non-participating provider level

    Does (86584WI0020005) Health Insurance Plan, Variant (86584WI0020005-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes, High Blood Pressure & High Cholesterol

    Does POS Bronze 7500 Health Insurance Plan, Variant (86584WI0020005-00) offer Disease Management Programs for Diabetes?

    Yes, the POS Bronze 7500 Health Insurance Plan Variant 86584WI0020005-00 offers Disease Management Program for Diabetes.

    Does POS Bronze 7500 Health Insurance Plan, Variant (86584WI0020005-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the POS Bronze 7500 Health Insurance Plan Variant 86584WI0020005-00 offers Disease Management Program for High blood pressure & high cholesterol.

 

Disclaimer: This is based on the import(Date: Tue, 13 May 2025 06:05 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