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
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).

Providers Arkansas All US States
All 584 5634
PCP 89 835
Allergy N/A 6
OB/GYN 5 34
Dentists 20 287
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

87% AV Silver Plan - 62141AR0080033-05

94% AV Silver Plan - 62141AR0080033-06

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

Frequently Asked Questions(FAQ) about Standard Silver, 62141AR0080033 Health Insurance Plan, 62141AR0080033

  • 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?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, Pregnancy

    Does (62141AR0080033) Health Insurance Plan, Variant (62141AR0080033-05) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (62141AR0080033) Health Insurance Plan, Variant (62141AR0080033-05) 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 (62141AR0080033) Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, Pregnancy

    Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Asthma?

    Yes, the Standard Silver Health Insurance Plan Variant 62141AR0080033-05 offers Disease Management Program for Asthma.

    Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Heart disease?

    Yes, the Standard Silver Health Insurance Plan Variant 62141AR0080033-05 offers Disease Management Program for Heart disease.

    Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Diabetes?

    Yes, the Standard Silver Health Insurance Plan Variant 62141AR0080033-05 offers Disease Management Program for Diabetes.

    Does Standard Silver Health Insurance Plan, Variant (62141AR0080033-05) offer Disease Management Programs for Pregnancy?

    Yes, the Standard Silver Health Insurance Plan Variant 62141AR0080033-05 offers Disease Management Program 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