Standard High Gold - 36046MA0750113 Health Insurance Plan
Harvard Pilgrim Healthcare, Inc. health insurance plan with the Plan ID 36046MA0750113. The plan is called Standard High Gold.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 82.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.00% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 36046MA0750113 | ||||||||||||||||||
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| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Massachusetts | ||||||||||||||||||
| Health Insurance Issuer | Harvard Pilgrim Healthcare, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 36046MA0750113-01 | ||||||||||||||||||
| Provider Network(s) | ['MAN001'] | ||||||||||||||||||
| 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 - 36046MA0750113-01 |
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| Last Plan Update Date | Mon, 22 May 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Standard High Gold Health Insurance Plan Variant 36046MA0750113-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| 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 person not applicable | per group 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 | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 | 99.67% |
| First Tier Utilization | 100% |
| Formulary ID | MAF005 |
| HIOS Product ID | 36046MA075 |
| Import Date | 5/22/2023 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 82.00% |
| Issuer ID | 36046 |
| 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 | 0.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MAN001 |
| 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) | 36046MA0750113-01 |
| Plan Marketing Name | Standard High Gold |
| Plan Type | HMO |
| Plan Variant Marketing Name | Standard High Gold |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,300 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $10 |
| SBC Scenario, Having Diabetes, Copayment | $1,400 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $50 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $800 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MAS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers. |
| Plan ID | 36046MA0750113 |
| State Code | MA |
| 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 | $5000 per person | $10000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $5,000 |
| 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 | Yes |
Copay & Coinsurance of Standard High Gold Health Insurance Plan, 36046MA0750113
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Standard High Gold, 36046MA0750113 Health Insurance Plan, 36046MA0750113
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Does Standard High Gold Health Insurance Plan, 36046MA0750113 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (36046MA0750113) Health Insurance Plan, Variant (36046MA0750113-01) 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 (36046MA0750113) Health Insurance Plan, Variant (36046MA0750113-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (36046MA0750113) Health Insurance Plan, Variant (36046MA0750113-01) 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 (36046MA0750113) Health Insurance Plan, Variant (36046MA0750113-01) 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 Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for Asthma?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 offers Disease
Management Program for Asthma.
Does Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for Heart disease?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 offers Disease
Management Program for Heart disease.
Does Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for Depression?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 offers Disease
Management Program for Depression.
Does Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for Diabetes?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 offers Disease
Management Program for Diabetes.
Does Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for Low back pain?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 offers Disease
Management Program for Low back pain.
Does Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for Pregnancy?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 offers Disease
Management Program for Pregnancy.
Does Standard High Gold Health Insurance Plan, Variant (36046MA0750113-01) offer Disease Management Programs for Weight loss programs?
Yes, the Standard High Gold Health Insurance Plan Variant
36046MA0750113-01 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