SelectHealth Value Silver Medicaid Transition Plan - 84445NV0030010 Health Insurance Plan
SelectHealth health insurance plan with the Plan ID 84445NV0030010. The plan is called SelectHealth Value Silver Medicaid Transition Plan.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.20% (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 28.80% 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 | 84445NV0030010 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Nevada | ||||||||||||||||||
| Health Insurance Issuer | SelectHealth | ||||||||||||||||||
| Health Insurance Plan Variant | 84445NV0030010-01 | ||||||||||||||||||
| Provider Network(s) | ['NVN001'] | ||||||||||||||||||
| 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 - 84445NV0030010-01 Open to Indians below 300% FPL - 84445NV0030010-02 Open to Indians above 300% FPL - 84445NV0030010-03 73% AV Silver Plan - 84445NV0030010-04 |
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| Last Plan Update Date | Mon, 17 Apr 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant 84445NV0030010-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.711998057 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | $500 per person | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $500 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | NVF002 |
| HIOS Product ID | 84445NV003 |
| Import Date | 4/17/2023 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 84445 |
| 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 | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $6000 per person | $12000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $6,000 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | NVN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 84445NV0030010-01 |
| 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; 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; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; 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 Value Silver Medicaid Transition Plan |
| Plan Type | HMO |
| Plan Variant Marketing Name | SelectHealth Value Silver Medicaid Transition Plan |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,700 |
| SBC Scenario, Having a Baby, Copayment | $300 |
| SBC Scenario, Having a Baby, Deductible | $6,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $800 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NVS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Except for general ophthalmology, gynecological and obstetrical, general podiatry, mental health and substance abuse, services received from a Secondary Care Provider or ancillary Provider require a referral from your Primary Care Provider. |
| Plan ID | 84445NV0030010 |
| State Code | NV |
| 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 | 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 | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, 84445NV0030010
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about SelectHealth Value Silver Medicaid Transition Plan, 84445NV0030010 Health Insurance Plan, 84445NV0030010
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Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, 84445NV0030010 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (84445NV0030010) Health Insurance Plan, Variant (84445NV0030010-01) 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 (84445NV0030010) Health Insurance Plan, Variant (84445NV0030010-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (84445NV0030010) Health Insurance Plan, Variant (84445NV0030010-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan).
Does (84445NV0030010) Health Insurance Plan, Variant (84445NV0030010-01) 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 SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for Asthma?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 offers Disease
Management Program for Asthma.
Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for Heart disease?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 offers Disease
Management Program for Heart disease.
Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for Depression?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 offers Disease
Management Program for Depression.
Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for Diabetes?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 offers Disease
Management Program for Diabetes.
Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for Low back pain?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 offers Disease
Management Program for Low back pain.
Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for Pregnancy?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 offers Disease
Management Program for Pregnancy.
Does SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan, Variant (84445NV0030010-01) offer Disease Management Programs for Weight loss programs?
Yes, the SelectHealth Value Silver Medicaid Transition Plan Health Insurance Plan Variant
84445NV0030010-01 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