Standard Silver - 62141AR0080033 Health Insurance Plan
Celtic Insurance Company health insurance plan with the Plan ID 62141AR0080033. The plan is called Standard Silver.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 87.33% (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 12.67% 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 | 62141AR0080033 | ||||||||||||||||||
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| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Arkansas | ||||||||||||||||||
| Health Insurance Issuer | Celtic Insurance Company | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 62141AR0080033-05 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Jun 2025 06:07 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 62141AR0080033-00 Standard On Exchange Plan - 62141AR0080033-01 Open to Indians below 300% FPL - 62141AR0080033-02 Open to Indians above 300% FPL - 62141AR0080033-03 73% AV Silver Plan - 62141AR0080033-04 |
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| Last Plan Update Date | Mon, 12 Aug 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 10 Jun 2025 06:07 GMT |
Standard Silver Health Insurance Plan Variant 62141AR0080033-05 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.8733413803485369 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 87% AV Level Silver Plan |
| Dental Only Plan | No |
| Design Type | Design 1 |
| Disease Management Programs Offered | Asthma, Diabetes, Heart Disease, Pregnancy |
| EHB Percent of Total Premium | 0.9999621 |
| First Tier Utilization | 100% |
| Formulary ID | ARF008 |
| Formulary URL | URL |
| HIOS Product ID | 62141AR008 |
| Import Date | 2024-08-12 20:01:40 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 62141 |
| Issuer Marketplace Marketing Name | Ambetter from Arkansas Health & Wellness |
| Market Coverage | Individual |
| 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 | ARN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 62141AR0080033-05 |
| Plan Marketing Name | Standard Silver |
| Plan Type | PPO |
| Plan Variant Marketing Name | Standard Silver |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,500 |
| SBC Scenario, Having a Baby, Copayment | $20 |
| SBC Scenario, Having a Baby, Deductible | $500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $100 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $500 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ARS001 |
| Source Name | SERFF |
| Plan ID | 62141AR0080033 |
| State Code | AR |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $29000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $14500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $14,500 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $17300 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $8650 per person |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $8,650 |
| 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 Per Group | $1000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $500 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $500 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $16300 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $8150 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $8,150 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $6000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $3000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $3,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $23000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $11500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $11,500 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Standard Silver Health Insurance Plan, 62141AR0080033
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Standard Silver, 62141AR0080033 Health Insurance Plan, 62141AR0080033
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Does Standard Silver Health Insurance Plan, 62141AR0080033 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (62141AR0080033) Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs?
Does (62141AR0080033) Health Insurance Plan, Variant (62141AR0080033-05) have Out Of Country Coverage?
Does (62141AR0080033) Health Insurance Plan, Variant (62141AR0080033-05) have Out of Service Area Coverage?
Does (62141AR0080033) Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs?
Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Asthma?
Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Heart disease?
Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Diabetes?
Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 10 Jun 2025 06:07 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