Standard High Gold: Community Care Connector High Gold - 88806MA0100018 Health Insurance Plan
Fallon Community Health Plan health insurance plan with the Plan ID 88806MA0100018. The plan is called Standard High Gold: Community Care Connector High Gold.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 81.97% (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 18.03% 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 | 88806MA0100018 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Massachusetts | ||||||||||||||||||
| Health Insurance Issuer | Fallon Community Health Plan | ||||||||||||||||||
| Health Insurance Plan Variant | 88806MA0100018-01 | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 22 May 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Standard High Gold: Community Care Connector High Gold Health Insurance Plan Variant 88806MA0100018-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.819708858 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes |
| First Tier Utilization | 100% |
| Formulary ID | MAF002 |
| HIOS Product ID | 88806MA010 |
| HSA/HRA Employer Contribution | No |
| Import Date | 5/22/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 88806 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Only |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 88806MA0100018-01 |
| Plan Marketing Name | Standard High Gold: Community Care Connector High Gold |
| Plan Type | HMO |
| Plan Variant Marketing Name | Standard High Gold: Community Care Connector High Gold |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,510 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $2,210 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $90 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $1,330 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MAS002 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Allergist and Immunologist, Anesthesiologist, Cardiologist, Dermatologist, Doctor of Osteopathic Medicine, Endocrinologist, Gastroenterologists, Hematologists, Infection Diseases, Neonatologists, Neurologists, Nephrologists, Oncologists, Ophthalmologists, Orthopedic Surgeons, Otolaryngologists, Podiatrists, Pulmonologists, Rheumatologists, General Surgeons, Thoracic Surgeons, Vascular Surgeons, Urologists |
| Plan ID | 88806MA0100018 |
| 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 |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 | $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 | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Standard High Gold: Community Care Connector High Gold Health Insurance Plan, 88806MA0100018
| 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: Community Care Connector High Gold, 88806MA0100018 Health Insurance Plan, 88806MA0100018
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Does Standard High Gold: Community Care Connector High Gold Health Insurance Plan, 88806MA0100018 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (88806MA0100018) Health Insurance Plan, Variant (88806MA0100018-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes
Does (88806MA0100018) Health Insurance Plan, Variant (88806MA0100018-01) have Out Of Country Coverage?
Yes. Details: Emergency Only
Does (88806MA0100018) Health Insurance Plan, Variant (88806MA0100018-01) 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 (88806MA0100018) Health Insurance Plan, Variant (88806MA0100018-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes
Does Standard High Gold: Community Care Connector High Gold Health Insurance Plan, Variant (88806MA0100018-01) offer Disease Management Programs for Asthma?
Yes, the Standard High Gold: Community Care Connector High Gold Health Insurance Plan Variant
88806MA0100018-01 offers Disease
Management Program for Asthma.
Does Standard High Gold: Community Care Connector High Gold Health Insurance Plan, Variant (88806MA0100018-01) offer Disease Management Programs for Heart disease?
Yes, the Standard High Gold: Community Care Connector High Gold Health Insurance Plan Variant
88806MA0100018-01 offers Disease
Management Program for Heart disease.
Does Standard High Gold: Community Care Connector High Gold Health Insurance Plan, Variant (88806MA0100018-01) offer Disease Management Programs for Diabetes?
Yes, the Standard High Gold: Community Care Connector High Gold Health Insurance Plan Variant
88806MA0100018-01 offers Disease
Management Program for Diabetes.
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