UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) - 97560MS0080003 Health Insurance Plan

UnitedHealthcare of Mississippi, Inc. health insurance plan with the Plan ID 97560MS0080003. The plan is called UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 79.62% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 20.38% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 97560MS0080003
Health Insurance Plan Year 2025
State Mississippi
Health Insurance Issuer UnitedHealthcare of Mississippi, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 97560MS0080003-00
Provider Network(s) NETWORK NON-PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Mississippi All US States
All 6949 57056
PCP 852 1644
Allergy 1 7
OB/GYN 21 72
Dentists 7 13
Available Variants of the Health Plan

Standard Off Exchange Plan - 97560MS0080003-00

Standard On Exchange Plan - 97560MS0080003-01

Open to Indians below 300% FPL - 97560MS0080003-02

Open to Indians above 300% FPL - 97560MS0080003-03

Last Plan Update Date Fri, 16 Aug 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Health Insurance Plan, 97560MS0080003-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
YES

45.00%

100.00%
Acupuncture
NO
Allergy Testing
YES

$60.00

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult

Limit: 1000.0 Dollars per Year

1,000 annual benefit maximum includes all Dental Services (Routine, Basic and Major) for Adults; Excluded from In-Network Deductible and Out-of-Pocket Limit

YES

50.00%

100.00%
Basic Dental Care - Child

Benefit limitations may apply to individual services.

YES

45.00%

100.00%
Chemotherapy
YES

$500.00

100.00%
Chiropractic Care

Limit: 20.0 Visit(s) per Year

Limited to 20 visits for any combination of manipulative treatment, physical therapy and occupational therapy.

YES

45.00%

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Childbirth/delivery professional services follow inpatient physician/surgeon fees.

YES

$2,000.00

100.00%
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

YES

No Charge

100.00%
Diabetes Education
YES

45.00%

100.00%
Dialysis
YES

$500.00

100.00%
Durable Medical Equipment
YES

45.00%

100.00%
Emergency Room Services
YES

$750.00

$750.00
Emergency Transportation/Ambulance
YES

$750.00

$750.00
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

45.00%

100.00%
Gender Affirming Care

Covered when medically necessary.

YES

$300.00

100.00%
Generic Drugs

Limit: 30.0 Days per Month

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$1.00

100.00%
Habilitation Services
YES

$60.00

100.00%
Hearing Aids
NO
Home Health Care Services
YES

45.00%

100.00%
Hospice Services
YES

45.00%

100.00%
Imaging (CT/PET Scans, MRIs)
YES

$300.00

100.00%
Infertility Treatment
NO
Infusion Therapy
YES

$75.00

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

$2000.00 Copay per Day

100.00%
Inpatient Physician and Surgical Services
YES

No Charge

100.00%
Laboratory Outpatient and Professional Services
YES

$10.00

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult

Limit: 1000.0 Dollars per Year

1,000 annual benefit maximum includes all Dental Services (Routine, Basic and Major) for Adults; Excluded from In-Network Deductible and Out-of-Pocket Limit

YES

50.00%

100.00%
Major Dental Care - Child

Benefit limitations may apply to individual services.

YES

45.00%

100.00%
Mental/Behavioral Health Inpatient Services
YES

$2000.00 Copay per Day

100.00%
Mental/Behavioral Health Outpatient Services

Cost share applies to office visits, please see SBC for Mental Health Outpatient Services.

YES

$40.00

100.00%
Non-Preferred Brand Drugs

Limit: 30.0 Days per Month

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

45.00% Coinsurance after deductible

100.00%
Nutritional Counseling

Medical or behavioral/mental health related nutritional education services that are provided as part of treatment for a disease are covered

NO
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

45.00%

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

$300.00

100.00%
Outpatient Rehabilitation Services

Limit: 40.0 Visit(s) per Year

Limited to 20 visits per year for speech therapy, and 20 visits for any combination of manipulative treatment, physical therapy and occupational therapy. Cardiac rehabilitation is covered and limited to 36 visits per year.

YES

$60.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

$300.00

100.00%
Preferred Brand Drugs

Limit: 30.0 Days per Month

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$50.00

100.00%
Prenatal and Postnatal Care
YES

No Charge

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

Cost sharing for Virtual Primary Care matches in-person office visit.

YES

$1.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

45.00%

100.00%
Radiation
YES

$75.00

100.00%
Reconstructive Surgery

Reconstructive procedures are covered when the primary purpose of the procedure is either treatment of a medical condition or required to improve or restore physiologic function.

YES

$300.00

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 20.0 Visit(s) per Year

Limited to 20 visits for any combination of physical therapy and occupational therapy.

YES

$60.00

100.00%
Rehabilitative Speech Therapy

Limit: 20.0 Visit(s) per Year

YES

$60.00

100.00%
Routine Dental Services (Adult)

Limit: 2.0 Visit(s) per Year

1,000 annual benefit maximum includes all Dental Services (Routine, Basic and Major) for Adults; Excluded from In-Network Deductible and Out-of-Pocket Limit

YES

No Charge

100.00%
Routine Eye Exam (Adult)

Limit: 1.0 Visit(s) per Year

Benefit also includes 1 pair of eyeglasses or contact lenses every 12 months. Eyeglass lenses have a $25 copay and frames are covered up to $150. Formulary contact lenses are covered in lieu of glasses with a $25 copay.

YES

No Charge

100.00%
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

YES

No Charge

100.00%
Routine Foot Care

Covered as medically necessary for the prevention of complications associated with metabolic, neurologic, or peripheral vascular disease

YES

$60.00

100.00%
Skilled Nursing Facility

Limit: 60.0 Days per Year

Limit will be 60 days per benefit period for Skilled Nursing Facility. Limits will be 30 days per benefit period for inpatient rehabilitation

YES

$2000.00 Copay per Day

100.00%
Specialist Visit
YES

$60.00

100.00%
Specialty Drugs

Limit: 30.0 Days per Month

Specialty medications are limited to a 1-month supply. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

50.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

$2000.00 Copay per Day

100.00%
Substance Abuse Disorder Outpatient Services
YES

$40.00

100.00%
Transplant
YES

$2,000.00

100.00%
Treatment for Temporomandibular Joint Disorders
YES

45.00%

100.00%
Urgent Care Centers or Facilities

$0 Virtual Urgent Care visits are available through vendor. See SBC for additional cost share details for in-person urgent care visits.

YES

$50.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

$60.00

100.00%

UHC Gold-X Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Health Insurance Plan Variant 97560MS0080003-00 Attributes

Plan Attribute Value
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 Standard Gold Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person 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 Per Group $1000 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $500 per person
Drug EHB Deductible, In Network (Tier 1), Individual $500
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Design Type Not Applicable
EHB Percent of Total Premium 0.97620004
First Tier Utilization 100%
Formulary ID MSF034
Formulary URL URL
HIOS Product ID 97560MS008
Import Date 2024-08-16 01:01:20
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 3
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 79.62%
Issuer ID 97560
Issuer Marketplace Marketing Name UnitedHealthcare
Market Coverage Individual
Medical Drug Deductibles Integrated No
Medical Drug Maximum Out of Pocket Integrated Yes
Medical EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 45.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Medical EHB Deductible, In Network (Tier 1), Individual $0
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Out of Network, Individual Not Applicable
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID MSN011
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The Network Area may include select Network providers located in a neighboring state. The plan also covers emergency health care services received outside the service area.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 97560MS0080003-00
Plan Level Exclusions Some exclusions may apply. See the applicable Certificate of Coverage for details.
Plan Marketing Name UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
Plan Type HMO
Plan Variant Marketing Name UHC Gold-X Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $2,400
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 $400
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $20
SBC Scenario, Treatment of a Simple Fracture, Copayment $2,000
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MSS011
Source Name HIOS
Plan ID 97560MS0080003
State Code MS
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person 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 Per Group $18000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Health Insurance Plan, 97560MS0080003

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals), 97560MS0080003 Health Insurance Plan, 97560MS0080003

  • Does UHC Gold Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals) Health Insurance Plan, 97560MS0080003 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (97560MS0080003) Health Insurance Plan, Variant (97560MS0080003-00) have Out Of Country Coverage?

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

    Does (97560MS0080003) Health Insurance Plan, Variant (97560MS0080003-00) have Out of Service Area Coverage?

    Yes. Details: Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The Network Area may include select Network providers located in a neighboring state. The plan also covers emergency health care services received outside the service area.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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