Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, - 74289NY2780071 Health Insurance Plan
Oscar Insurance Corporation health insurance plan with the Plan ID 74289NY2780071. The plan is called Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP,.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.01% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.99% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 74289NY2780071 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New York | ||||||||||||||||||
| Health Insurance Issuer | Oscar Insurance Corporation | ||||||||||||||||||
| Health Insurance Plan Variant | 74289NY2780071-01 | ||||||||||||||||||
| 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 |
Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant 74289NY2780071-01 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 | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 70.01% |
| Issuer ID | 74289 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| 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) | 74289NY2780071-01 |
| Plan Marketing Name | Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, |
| Plan Type | EPO |
| Plan Variant Marketing Name | Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,400 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $3,250 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $600 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $3,250 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| 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 | NYS001 |
| Source Name | SERFF |
| Plan ID | 74289NY2780071 |
| 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 | 30.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $3250 per person | $6500 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,250 |
| 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 | $6700 per person | $13400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $6,700 |
| 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 Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, 74289NY2780071
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP,, 74289NY2780071 Health Insurance Plan, 74289NY2780071
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Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, 74289NY2780071 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (74289NY2780071) Health Insurance Plan, Variant (74289NY2780071-01) 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 (74289NY2780071) Health Insurance Plan, Variant (74289NY2780071-01) have Out Of Country Coverage?
Yes. Details: Emergency Services only.
Does (74289NY2780071) Health Insurance Plan, Variant (74289NY2780071-01) have Out of Service Area Coverage?
Yes. Details: Emergency and Urgent Services only.
Does (74289NY2780071) Health Insurance Plan, Variant (74289NY2780071-01) 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 Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for Asthma?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 offers Disease
Management Program for Asthma.
Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for Heart disease?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 offers Disease
Management Program for Heart disease.
Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for Depression?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 offers Disease
Management Program for Depression.
Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for Diabetes?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 offers Disease
Management Program for Diabetes.
Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for Low back pain?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 offers Disease
Management Program for Low back pain.
Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for Pregnancy?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 offers Disease
Management Program for Pregnancy.
Does Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan, Variant (74289NY2780071-01) offer Disease Management Programs for Weight loss programs?
Yes, the Silver $3250 HSA, INN, Circle, Dep 25, Pediatric Dental, FP, Health Insurance Plan Variant
74289NY2780071-01 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