UHC Choice Plus Silver 4250 - 41842DC0080033 Health Insurance Plan
UnitedHealthcare Insurance Company health insurance plan with the Plan ID 41842DC0080033. The plan is called UHC Choice Plus Silver 4250.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 72.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.00% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 41842DC0080033 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | District of Columbia | ||||||||||||||||||
| Health Insurance Issuer | UnitedHealthcare Insurance Company | ||||||||||||||||||
| Health Insurance Plan Variant | 41842DC0080033-01 | ||||||||||||||||||
| Provider Network(s) | ['DCN001'] | ||||||||||||||||||
| 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, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
UHC Choice Plus Silver 4250 Health Insurance Plan Variant 41842DC0080033-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver 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 | $500 per person | per group not applicable |
| Drug EHB Deductible, In Network (Tier 1), Individual | $500 |
| Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 2), Family | $500 per person | per group not applicable |
| Drug EHB Deductible, In Network (Tier 2), Individual | $500 |
| Drug EHB Deductible, Out of Network, Family | $500 per person | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | $500 |
| Dental Only Plan | No |
| Disease Management Programs Offered | Heart Disease, Diabetes, Pregnancy |
| First Tier Utilization | 43.50 |
| Formulary ID | DCF020 |
| HIOS Product ID | 41842DC008 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 72.00% |
| Issuer ID | 41842 |
| Market Coverage | SHOP (Small Group) |
| 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 | 30.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $4250 per person | $8500 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $4,250 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 30.00% |
| Medical EHB Deductible, In Network (Tier 2), Family | $4250 per person | $8500 per group |
| Medical EHB Deductible, In Network (Tier 2), Individual | $4,250 |
| Medical EHB Deductible, Out of Network, Family | $10000 per person | $20000 per group |
| Medical EHB Deductible, Out of Network, Individual | $10,000 |
| Metal Level | Silver |
| Multiple In Network Tiers | Yes |
| National Network | Yes |
| Network ID | DCN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Yes, enter With Network Provider, same as other Network Benefits |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 41842DC0080033-01 |
| Plan Level Exclusions | No |
| Plan Marketing Name | UHC Choice Plus Silver 4250 |
| Plan Type | POS |
| Plan Variant Marketing Name | UHC Choice Plus Silver 4250 |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $400 |
| SBC Scenario, Having a Baby, Deductible | $4,200 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,200 |
| SBC Scenario, Having Diabetes, Deductible | $600 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $90 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,400 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 56.50 |
| Service Area ID | DCS001 |
| Source Name | SERFF |
| Plan ID | 41842DC0080033 |
| State Code | DC |
| 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 | $8900 per person | $17800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,900 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family | $8900 per person | $17800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $8,900 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $15000 per person | $30000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $15,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of UHC Choice Plus Silver 4250 Health Insurance Plan, 41842DC0080033
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about UHC Choice Plus Silver 4250, 41842DC0080033 Health Insurance Plan, 41842DC0080033
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Does UHC Choice Plus Silver 4250 Health Insurance Plan, 41842DC0080033 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (41842DC0080033) Health Insurance Plan, Variant (41842DC0080033-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Heart Disease, Diabetes, Pregnancy
Does (41842DC0080033) Health Insurance Plan, Variant (41842DC0080033-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (41842DC0080033) Health Insurance Plan, Variant (41842DC0080033-01) have Out of Service Area Coverage?
Yes. Details: Yes, enter With Network Provider, same as other Network Benefits
Does (41842DC0080033) Health Insurance Plan, Variant (41842DC0080033-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Heart Disease, Diabetes, Pregnancy
Does UHC Choice Plus Silver 4250 Health Insurance Plan, Variant (41842DC0080033-01) offer Disease Management Programs for Heart disease?
Yes, the UHC Choice Plus Silver 4250 Health Insurance Plan Variant
41842DC0080033-01 offers Disease
Management Program for Heart disease.
Does UHC Choice Plus Silver 4250 Health Insurance Plan, Variant (41842DC0080033-01) offer Disease Management Programs for Diabetes?
Yes, the UHC Choice Plus Silver 4250 Health Insurance Plan Variant
41842DC0080033-01 offers Disease
Management Program for Diabetes.
Does UHC Choice Plus Silver 4250 Health Insurance Plan, Variant (41842DC0080033-01) offer Disease Management Programs for Pregnancy?
Yes, the UHC Choice Plus Silver 4250 Health Insurance Plan Variant
41842DC0080033-01 offers Disease
Management Program for Pregnancy.
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