Arkansas health plan · 2026

Standard Silver (QualChoiceLife) · 37903AR0070033

QualChoice Life and Health Insurance Company, Inc. offers this marketplace health insurance plan (Plan ID 37903AR0070033) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: PPO CSR: 94% AV Level Silver Plan Issuer: QualChoice Life and Health Insurance Company, Inc.
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 94.11% (5.89% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$496 – $1944

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$2,200

$4400 per group

Review MOOP rules

Office visits

Primary care $0.00
Specialist $10.00
HSA Not eligible

Drug tiers

Generic $0.00
Preferred brand $15.00

View formulary tiers

$679 / mo before subsidies

≈ $8149 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$2152 / mo before subsidies

≈ $25822 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2606 / mo before subsidies

≈ $31272 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1656 / mo before subsidies

≈ $19874 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

25.00%

Durable Medical Equipment

25.00%

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Arkansas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 94% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

25.00%

Durable Medical Equipment

25.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 37903AR0070033
Coverage year 2026
State Arkansas
Issuer QualChoice Life and Health Insurance Company, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 37903AR0070033-06
Available variants

Standard Off Exchange Plan · 37903AR0070033-00

Standard On Exchange Plan · 37903AR0070033-01

Open to Indians below 300% FPL · 37903AR0070033-02

Open to Indians above 300% FPL · 37903AR0070033-03

73% AV Silver Plan · 37903AR0070033-04

87% AV Silver Plan · 37903AR0070033-05

94% AV Silver Plan · 37903AR0070033-06
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Arkansas 5176
PCPs in Arkansas 646
Telehealth support Data pending
Nationwide providers 50295
5,176 doctors statewide 646 PCPs 17 OB/GYN

Provider network(s)

Providers Arkansas All US states
All 5176 50295
PCP 646 6470
Allergy 3 40
OB/GYN 17 203
Dentists 127 2410

Drug coverage overview

4,670 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,656
NON-PREFERREDGENERIC-NON-PREFERREDBRAND 2,014
Prior authorization Drugs
Required 1,232
Not Required 3,438
Step therapy Drugs
Required 75
Not Required 4,595
Quantity limits Drugs
Has Limit 2,159
No Limit 2,511

Customer highlights

What stands out for members

  • Issuer: QualChoice Life and Health Insurance Company, Inc. · Plan ID 37903AR0070033 · 2026 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 37903AR0070033-06 (94% AV Silver Plan ) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$10.00
Tier 1 in-network $10.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Diabetes Care Management

$10.00
Tier 1 in-network $10.00
Out-of-network 60.00% Coinsurance after deductible

Diabetes Education

$10.00
Tier 1 in-network $10.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Home Health Care Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Limit: 50.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card.

Laboratory Outpatient and Professional Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Laboratory services provided to treat a behavioral health diagnosis fall under mental/behavioral health services. Coverage includes medically necessary biomarker testing.

Mental/Behavioral Health Urgent Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Other Practitioner Office Visit (Nurse, Physician Assistant)

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Benefits include covered services rendered by a certified community health worker within their scope of certification.

Preventive Care/Screening/Immunization

0.00%
Tier 1 in-network 0.00%
Out-of-network 60.00% Coinsurance after deductible

Covered in accordance with ACA guidelines.

Primary Care Visit to Treat an Injury or Illness

$0.00
Tier 1 in-network $0.00
Out-of-network 60.00% Coinsurance after deductible

Rehabilitative Occupational and Rehabilitative Physical Therapy

$0.00
Tier 1 in-network $0.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

60 inpatient days/year. Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Rehabilitative Speech Therapy

$0.00
Tier 1 in-network $0.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Specialist Visit

$10.00
Tier 1 in-network $10.00
Out-of-network 60.00% Coinsurance after deductible

Specialist visits provided to treat a behavioral health diagnosis fall under mental/behavioral health services.

Substance Use Disorder Urgent Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Urgent Care Centers or Facilities

$5.00
Tier 1 in-network $5.00
Out-of-network 60.00% Coinsurance after deductible

X-rays and Diagnostic Imaging

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Delivery and All Inpatient Services for Maternity Care

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Dialysis

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Durable Medical Equipment

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Emergency Room Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Emergency Transportation/Ambulance

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Hospice Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Inpatient Hospital Services (e.g., Hospital Stay)

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Inpatient Physician and Surgical Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental/Behavioral Health Emergency Room

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Mental/Behavioral Health Emergency Transportation/Ambulance

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Mental/Behavioral Health Inpatient Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental/Behavioral Health Outpatient Other Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Note: Cost share will be waived for Behavioral Health screening services.

Mental/Behavioral Health Outpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 60.00% Coinsurance after deductible

Cost sharing shown applies to outpatient office visits only. See Summary of Benefits and Coverage and the policy for more information on an additional outpatient category, Other Outpatient Services, which may apply a different cost share amount and require prior authorization. Note: Office visits do not require prior authorization. Cost share will be waived for Behavioral Health screening services.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Outpatient Rehabilitation Services

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient physical therapy, speech therapy, occupational therapy, and chiropractic care. Note: Limits do not apply when provided for a mental health/substance use disorder diagnosis.

Outpatient Surgery Physician/Surgical Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Radiation

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Skilled Nursing Facility

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Limit: 60.0 Days per Year

Prior authorization may be required - please contact the number listed on your ID card.

Substance Abuse Disorder Inpatient Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Substance Abuse Disorder Outpatient Services

$0.00
Tier 1 in-network $0.00
Out-of-network 60.00% Coinsurance after deductible

Cost sharing shown applies to outpatient office visits only. See Summary of Benefits and Coverage and the policy for more information on an additional outpatient category, Other Outpatient Services, which may apply a different cost share amount and require prior authorization. Note: Office visits do not require prior authorization. Cost share will be waived for Behavioral Health screening services.

Substance Use Disorder Emergency Room

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Substance Use Disorder Emergency Transportation/Ambulance

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Prior authorization is not required for emergency transport, however, all non-emergent transport requires prior authorization.

Substance Use Disorder Outpatient Other Services

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Note: Cost share will be waived for Behavioral Health screening services.

Transplant

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Mental health & substance use

Behavioral health visits and substance use treatment.

Mental/Behavioral Health ER Physician Fee

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Substance Use Disorder ER Physician Fee

25.00%
Tier 1 in-network 25.00%
Out-of-network 25.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00%

Limit: 2.0 Item(s) per 3 Years

Prior authorization may be required - please contact the number listed on your ID card.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Coverage includes services rendered by a certified community based doula within the scope of their certification.

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1.0 Exam(s) per Year

Up to $38.50 OON

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Up to a 30 day supply at any participating pharmacy or up to a 90 day supply at a 90 day retail pharmacy. Refer to the prescription drug list for more information.

Non-Preferred Brand Drugs

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Off Label Prescription Drugs

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Preferred Brand Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Preventative Drugs

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Specialty Drugs

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Anesthesia

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card. Coverage includes IVG treatment for PANS/PANDA diagnosis.

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

$10.00
Tier 1 in-network $10.00
Out-of-network 60.00% Coinsurance after deductible

Nutritional counseling provided to treat a behavioral health diagnosis falls under mental/behavioral health services.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Treatment

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for the medically necessary treatment of severy obesity including bariatric surgery, preoperative, and postoperative care.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acquired Brain Injury

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for medically necessary treatments related to an aquired brain injury. See EOC for a list of covered services.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

$10.00
Tier 1 in-network $10.00
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Applied Behavior Analysis Based Therapies

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Applied behavior analysis therapies provided to treat a behavioral health diagnosis falls under mental/behavioral health services.

Bariatric Surgery

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for medically necessary expenses for the treatment of diseases and conditions caused by severe obesity. Prior authorization may be required - please contact the number listed on your ID card.

Biomarke

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for medically necessary genetic/molecular cancer biomarker testing.

Cardiac Rehabilitation

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Limit: 36.0 Visit(s) per Year

Cochlear Implants

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00%

Community Health Worke

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Covered services must be rendered by a certified community health worker performing services within their scope of certification.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Craniofacial Surgery

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for craniofacial anomaly diagnosis where surgery and treatment are medically necessary to improve functional impairment.

Doulas

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Coverage includes services rendered by a certified community based doula within the scope of their certification.

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Limit: 1.0 Item(s) per Year

OON: Up to $50 for frames, $37.50 for lenses and $91 for contacts in lieu of eyeglasses. See EOC for lens limits.

Gastric Electrical Stimulation

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Habilitation Services

$0.00
Tier 1 in-network $0.00
Out-of-network 60.00% Coinsurance after deductible

Limit: 30.0 Visit(s) per Year

Prior authorization may be required - please contact the number listed on your ID card. Limited to a combined 30 visit limit per year for outpatient habilitation services; limited to 180 visits per year for developmental services. Habilitation services provided to treat a behavioral health diagnosis fall under mental/behavioral health services. Limits do not apply to mental/behavioral health services.

Imaging (CT/PET Scans, MRIs)

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Infertility Treatment

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required. Coverage includes testing to diagnose infertility, infertility counseling and planning services. Additionally, in vitro fertilization procedures and restorative reproductive treatments are covered.

Inherited Metabolic Disorder - PKU

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

PANS-PANDA

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for off-label use of intravenous immunoglobulin for the diagnosis of PANS, PANDA, or both.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

1. Treatment provided for the correction of defects incurred in an Accidental Injury sustained by the Member; 2. Surgery performed on a child for the correction of a cleft palate or cleft lip, removal of a port-wine stain or hemangioma (only on the face), or correction of a congenital abnormality; 3. Treatment provided when it is incidental to disease or for reconstructive surgery following neoplastic (cancer) surgery; 4. In connection with a mastectomy resulting from cancer surgery, services for (a) reconstruction of the breast on which the cancer-related surgery was performed; (b) surgery to reconstruct the other breast to produce a symmetrical appearance; and (c) prostheses and services to correct physical complications for all stages of the mastectomy, including lymphedemas; 5. Reduction mammoplasty, if such reduction mammoplasty meets Coverage Criteria. Prior Authorization may be required - please contact the number listed on your ID card.

Restorative Reproductive Treatment

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Coverage provided for patients with a history of unexplained infertility of at least 2 years duration, or for medical conditions including endometriosis, in utero exposure to diethylstilbestrol, blockage/removal of one/both fallopian tubes, or abnormal male factors contributing to infertility.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

$10.00
Tier 1 in-network $10.00
Out-of-network 60.00% Coinsurance after deductible

Treatment for Temporomandibular Joint Disorders

25.00%
Tier 1 in-network 25.00%
Out-of-network 60.00% Coinsurance after deductible

Prior authorization may be required - please contact the number listed on your ID card.

Well Child Care

No Charge
Tier 1 in-network No Charge
Out-of-network 60.00% Coinsurance after deductible

Variant attributes

Standard Silver (QualChoiceLife) · Variant 37903AR0070033-06

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

94% AV Level Silver Plan

HIOS Product ID

37903AR007

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

37903AR0070033-06

Plan Marketing Name

Standard Silver (QualChoiceLife)

Plan Variant Marketing Name

Standard Silver (QualChoiceLife)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

37903

Issuer Marketplace Marketing Name

Ambetter from Arkansas Health & Wellness

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

ARN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

ARS001

State Code

AR

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.9411075

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$2,200

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$200

SBC Scenario, Having Diabetes, Copayment

$200

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$500

SBC Scenario, Treatment of a Simple Fracture, Copayment

$30

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$54400 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$27200 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$27,200

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

25.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$4400 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$2200 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$2,200

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$50000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$25000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$25,000

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ARF004

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Design 1

Disease Management Programs Offered

Asthma, Diabetes, Heart Disease, Pregnancy

EHB Percent of Total Premium

0.999581184

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Type

PPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

37903AR0070033

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$30000 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$15000 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$15,000

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$30000 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$15000 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$15,000

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Arkansas?

Standard Silver (QualChoiceLife) (37903AR0070033) is a Silver PPO from QualChoice Life and Health Insurance Company, Inc. in Arkansas for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Standard Silver (QualChoiceLife) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Standard Silver (QualChoiceLife) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Standard Silver (QualChoiceLife) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Standard Silver (QualChoiceLife)?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, Pregnancy.

Is there out-of-country coverage for Standard Silver (QualChoiceLife)?

No, out-of-country services are not covered for this plan.

Does Standard Silver (QualChoiceLife) cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

How do I enroll in or manage payments for Standard Silver (QualChoiceLife)?

Use the issuer portal https://www.ambetterhealth.com/en/ar/payments to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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