Silver Pathway CT PPO w HSA - 86545CT1260014 Health Insurance Plan
Anthem Health Plans, Inc. health insurance plan with the Plan ID 86545CT1260014. The plan is called Silver Pathway CT PPO w HSA.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.76% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.24% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.90% (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 29.10% 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 | 86545CT1260014 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Connecticut | ||||||||||||||||||
| Health Insurance Issuer | Anthem Health Plans, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 86545CT1260014-01 | ||||||||||||||||||
| Provider Network(s) | ['CTN005'] | ||||||||||||||||||
| 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 Pathway CT PPO w HSA Health Insurance Plan Variant 86545CT1260014-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.708978197 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pregnancy |
| First Tier Utilization | 100% |
| Formulary ID | CTF001 |
| HIOS Product ID | 86545CT126 |
| 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 | 70.76% |
| Issuer ID | 86545 |
| 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 | Yes |
| Network ID | CTN005 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Full Access |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Standard Bluecard PPO Network |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 86545CT1260014-01 |
| Plan Marketing Name | Silver Pathway CT PPO w HSA |
| Plan Type | PPO |
| Plan Variant Marketing Name | Silver Pathway CT PPO w HSA |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $1,400 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $3,000 |
| SBC Scenario, Having a Baby, Limit | $2,700 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,000 |
| SBC Scenario, Having Diabetes, Deductible | $3,000 |
| 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 | CTS004 |
| Source Name | SERFF |
| Plan ID | 86545CT1260014 |
| State Code | CT |
| 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $3000 per person | $6000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,000 |
| TEHBDedOutofNetFamily | $9000 per person | $18000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $9,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $7000 per person | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $21000 per person | $42000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $21,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Silver Pathway CT PPO w HSA Health Insurance Plan, 86545CT1260014
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Silver Pathway CT PPO w HSA, 86545CT1260014 Health Insurance Plan, 86545CT1260014
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Does Silver Pathway CT PPO w HSA Health Insurance Plan, 86545CT1260014 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (86545CT1260014) Health Insurance Plan, Variant (86545CT1260014-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does (86545CT1260014) Health Insurance Plan, Variant (86545CT1260014-01) have Out Of Country Coverage?
Yes. Details: Full Access
Does (86545CT1260014) Health Insurance Plan, Variant (86545CT1260014-01) have Out of Service Area Coverage?
Yes. Details: Standard Bluecard PPO Network
Does (86545CT1260014) Health Insurance Plan, Variant (86545CT1260014-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does Silver Pathway CT PPO w HSA Health Insurance Plan, Variant (86545CT1260014-01) offer Disease Management Programs for Asthma?
Yes, the Silver Pathway CT PPO w HSA Health Insurance Plan Variant
86545CT1260014-01 offers Disease
Management Program for Asthma.
Does Silver Pathway CT PPO w HSA Health Insurance Plan, Variant (86545CT1260014-01) offer Disease Management Programs for Heart disease?
Yes, the Silver Pathway CT PPO w HSA Health Insurance Plan Variant
86545CT1260014-01 offers Disease
Management Program for Heart disease.
Does Silver Pathway CT PPO w HSA Health Insurance Plan, Variant (86545CT1260014-01) offer Disease Management Programs for Depression?
Yes, the Silver Pathway CT PPO w HSA Health Insurance Plan Variant
86545CT1260014-01 offers Disease
Management Program for Depression.
Does Silver Pathway CT PPO w HSA Health Insurance Plan, Variant (86545CT1260014-01) offer Disease Management Programs for Diabetes?
Yes, the Silver Pathway CT PPO w HSA Health Insurance Plan Variant
86545CT1260014-01 offers Disease
Management Program for Diabetes.
Does Silver Pathway CT PPO w HSA Health Insurance Plan, Variant (86545CT1260014-01) offer Disease Management Programs for Pregnancy?
Yes, the Silver Pathway CT PPO w HSA Health Insurance Plan Variant
86545CT1260014-01 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