Premera Blue Cross Preferred Bronze 5800 HSA - 38344AK1070002 Health Insurance Plan
Premera Blue Cross Blue Shield of Alaska health insurance plan with the Plan ID 38344AK1070002. The plan is called Premera Blue Cross Preferred Bronze 5800 HSA.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 62.93% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 37.07% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 38344AK1070002 | ||||||||||||||||||
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| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Alaska | ||||||||||||||||||
| Health Insurance Issuer | Premera Blue Cross Blue Shield of Alaska | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 38344AK1070002-01 | ||||||||||||||||||
| Provider Network(s) | LEGACYANDDENTALSELECT | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 38344AK1070002-01 |
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| Last Plan Update Date | Fri, 10 Jan 2025 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 13 May 2025 06:05 GMT |
Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan Variant 38344AK1070002-01 Attributes
| Plan Attribute | Value |
|---|---|
| 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 On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Diabetes, Heart Disease |
| EHB Percent of Total Premium | 0.9988 |
| First Tier Utilization | 95% |
| Formulary ID | AKF005 |
| Formulary URL | URL |
| HIOS Product ID | 38344AK107 |
| Import Date | 2025-01-10 00:01:52 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | Yes |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 62.93% |
| Issuer ID | 38344 |
| Issuer Marketplace Marketing Name | Premera Blue Cross Blue Shield of Alaska |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | AKN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | If you're outside Alaska and Washington (the service area), covered services received from any provider licensed to provide the service will be paid the out of network benefit level (except emergencies). |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 38344AK1070002-01 |
| Plan Marketing Name | Premera Blue Cross Preferred Bronze 5800 HSA |
| Plan Type | PPO |
| Plan Variant Marketing Name | Premera Blue Cross Preferred Bronze 5800 HSA |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $2,200 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $5,800 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,400 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 5% |
| Service Area ID | AKS001 |
| Source Name | HIOS |
| Plan ID | 38344AK1070002 |
| State Code | AK |
| 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 | 35.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $11600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $5800 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $5,800 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $11600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $5800 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $5,800 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $34800 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $17400 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $17,400 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $16000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $16000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $8000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $8,000 |
| 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 | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan, 38344AK1070002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Premera Blue Cross Preferred Bronze 5800 HSA, 38344AK1070002 Health Insurance Plan, 38344AK1070002
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Does Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan, 38344AK1070002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (38344AK1070002) Health Insurance Plan, Variant (38344AK1070002-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease
Does (38344AK1070002) Health Insurance Plan, Variant (38344AK1070002-01) have Out Of Country Coverage?
Yes. Details: Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.
Does (38344AK1070002) Health Insurance Plan, Variant (38344AK1070002-01) have Out of Service Area Coverage?
Yes. Details: If you're outside Alaska and Washington (the service area), covered services received from any provider licensed to provide the service will be paid the out of network benefit level (except emergencies).
Does (38344AK1070002) Health Insurance Plan, Variant (38344AK1070002-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease
Does Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan, Variant (38344AK1070002-01) offer Disease Management Programs for Asthma?
Yes, the Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan Variant
38344AK1070002-01 offers Disease
Management Program for Asthma.
Does Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan, Variant (38344AK1070002-01) offer Disease Management Programs for Heart disease?
Yes, the Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan Variant
38344AK1070002-01 offers Disease
Management Program for Heart disease.
Does Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan, Variant (38344AK1070002-01) offer Disease Management Programs for Diabetes?
Yes, the Premera Blue Cross Preferred Bronze 5800 HSA Health Insurance Plan Variant
38344AK1070002-01 offers Disease
Management Program for Diabetes.
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