Sparrow PHP Gold 2000 Exclusive - 60829MI0190016 Health Insurance Plan

Physicians Health Plan health insurance plan with the Plan ID 60829MI0190016. The plan is called Sparrow PHP Gold 2000 Exclusive.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.57% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.43% 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 78.23% (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 21.77% 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 60829MI0190016
Health Insurance Plan Year 2022
State Michigan
Health Insurance Issuer Physicians Health Plan
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 60829MI0190016-01
Provider Network(s) ['MIN002']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 22 Oct 2024 06:47 GMT).

Providers Michigan All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 60829MI0190016-00

Standard On Exchange Plan - 60829MI0190016-01

Open to Indians below 300% FPL - 60829MI0190016-02

Open to Indians above 300% FPL - 60829MI0190016-03

Last Plan Update Date Tue, 17 Aug 2021 00:00 GMT
Last Import Date Tue, 22 Oct 2024 06:47 GMT

Sparrow PHP Gold 2000 Exclusive Health Insurance Plan Variant 60829MI0190016-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.782331765
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold On Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Drug EHB Deductible, In Network (Tier 1), Individual $0
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Disease Management Programs Offered Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID MIF002
Formulary URL URL
HIOS Product ID 60829MI019
Import Date 8/17/2021 20:00
Limited Cost Sharing Plan Variation - Estimated Advanced Payment 0
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 78.57%
Issuer ID 60829
Issuer Marketplace Marketing Name Physicians Health Plan
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 Group per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 30.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $4000 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $2000 per person
Medical EHB Deductible, In Network (Tier 1), Individual $2,000
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Out of Network, Individual Not Applicable
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID MIN002
Out of Country Coverage Yes
Out of Country Coverage Description Coverage for emergency and urgent care only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Coverage only for emergency health services and urgent care center visits at network benefit level
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 60829MI0190016-01
Plan Marketing Name Sparrow PHP Gold 2000 Exclusive
Plan Type HMO
Plan Variant Marketing Name Sparrow PHP Gold 2000 Exclusive
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,100
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $2,000
SBC Scenario, Having a Baby, Limit $50
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,600
SBC Scenario, Having Diabetes, Deductible $400
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $100
SBC Scenario, Treatment of a Simple Fracture, Copayment $400
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,000
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MIS004
Source Name SERFF
Plan ID 60829MI0190016
State Code MI
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
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $13600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6800 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,800
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 Yes

Copay & Coinsurance of Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, 60829MI0190016

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Sparrow PHP Gold 2000 Exclusive, 60829MI0190016 Health Insurance Plan, 60829MI0190016

  • Does Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, 60829MI0190016 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (60829MI0190016) Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does (60829MI0190016) Health Insurance Plan, Variant (60829MI0190016-01) have Out Of Country Coverage?

    Yes. Details: Coverage for emergency and urgent care only

    Does (60829MI0190016) Health Insurance Plan, Variant (60829MI0190016-01) have Out of Service Area Coverage?

    Yes. Details: Coverage only for emergency health services and urgent care center visits at network benefit level

    Does (60829MI0190016) Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs for Asthma?

    Yes, the Sparrow PHP Gold 2000 Exclusive Health Insurance Plan Variant 60829MI0190016-01 offers Disease Management Program for Asthma.

    Does Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs for Diabetes?

    Yes, the Sparrow PHP Gold 2000 Exclusive Health Insurance Plan Variant 60829MI0190016-01 offers Disease Management Program for Diabetes.

    Does Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Sparrow PHP Gold 2000 Exclusive Health Insurance Plan Variant 60829MI0190016-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs for Low back pain?

    Yes, the Sparrow PHP Gold 2000 Exclusive Health Insurance Plan Variant 60829MI0190016-01 offers Disease Management Program for Low back pain.

    Does Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs for Pregnancy?

    Yes, the Sparrow PHP Gold 2000 Exclusive Health Insurance Plan Variant 60829MI0190016-01 offers Disease Management Program for Pregnancy.

    Does Sparrow PHP Gold 2000 Exclusive Health Insurance Plan, Variant (60829MI0190016-01) offer Disease Management Programs for Weight loss programs?

    Yes, the Sparrow PHP Gold 2000 Exclusive Health Insurance Plan Variant 60829MI0190016-01 offers Disease Management Program for Weight loss programs.

 

Disclaimer: This is based on the import(Date: Tue, 22 Oct 2024 06:47 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