SelectHealth SLHP Bronze 7500 HSA Qualified - 26002ID0030016 Health Insurance Plan
SelectHealth health insurance plan with the Plan ID 26002ID0030016. The plan is called SelectHealth SLHP Bronze 7500 HSA Qualified.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.06% (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 36.94% 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 | 26002ID0030016 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | SelectHealth | ||||||||||||||||||
| Health Insurance Plan Variant | 26002ID0030016-01 | ||||||||||||||||||
| Provider Network(s) | ['IDN001'] | ||||||||||||||||||
| 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 |
SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant 26002ID0030016-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.630602565 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | Yes |
| CSR Variation Type | Standard Bronze On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Low Back Pain, High Blood Pressure & High Cholesterol |
| First Tier Utilization | 100% |
| Formulary ID | IDF005 |
| HIOS Product ID | 26002ID003 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 26002 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | IDN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Except for urgent and emergency care, out-of-network benefits apply to providers not in the network listed in your plan materials |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 26002ID0030016-01 |
| Plan Level Exclusions | Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gene Therapy; Hearing Aids where criteria is not met; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Travel-Related Expenses; computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items. |
| Plan Marketing Name | SelectHealth SLHP Bronze 7500 HSA Qualified |
| Plan Type | POS |
| Plan Variant Marketing Name | SelectHealth SLHP Bronze 7500 HSA Qualified |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| 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 | $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 |
| Service Area ID | IDS001 |
| Source Name | SERFF |
| Plan ID | 26002ID0030016 |
| State Code | ID |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | per person not applicable | $15000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,500 |
| TEHBDedOutofNetFamily | $18200 per person | $36400 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $18,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $7500 per person | $15000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $20000 per person | $40000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $20,000 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, 26002ID0030016
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about SelectHealth SLHP Bronze 7500 HSA Qualified, 26002ID0030016 Health Insurance Plan, 26002ID0030016
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Does SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, 26002ID0030016 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (26002ID0030016) Health Insurance Plan, Variant (26002ID0030016-01) 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 (26002ID0030016) Health Insurance Plan, Variant (26002ID0030016-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (26002ID0030016) Health Insurance Plan, Variant (26002ID0030016-01) have Out of Service Area Coverage?
Yes. Details: Except for urgent and emergency care, out-of-network benefits apply to providers not in the network listed in your plan materials
Does (26002ID0030016) Health Insurance Plan, Variant (26002ID0030016-01) 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 SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, Variant (26002ID0030016-01) offer Disease Management Programs for Asthma?
Yes, the SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant
26002ID0030016-01 offers Disease
Management Program for Asthma.
Does SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, Variant (26002ID0030016-01) offer Disease Management Programs for Heart disease?
Yes, the SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant
26002ID0030016-01 offers Disease
Management Program for Heart disease.
Does SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, Variant (26002ID0030016-01) offer Disease Management Programs for Depression?
Yes, the SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant
26002ID0030016-01 offers Disease
Management Program for Depression.
Does SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, Variant (26002ID0030016-01) offer Disease Management Programs for Diabetes?
Yes, the SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant
26002ID0030016-01 offers Disease
Management Program for Diabetes.
Does SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, Variant (26002ID0030016-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant
26002ID0030016-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, Variant (26002ID0030016-01) offer Disease Management Programs for Low back pain?
Yes, the SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant
26002ID0030016-01 offers Disease
Management Program for Low back pain.
Does SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan, Variant (26002ID0030016-01) offer Disease Management Programs for Pregnancy?
Yes, the SelectHealth SLHP Bronze 7500 HSA Qualified Health Insurance Plan Variant
26002ID0030016-01 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