UHC OCI Platinum 250 - 75753DC0030013 Health Insurance Plan
Optimum Choice, Inc. health insurance plan with the Plan ID 75753DC0030013. The plan is called UHC OCI Platinum 250.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 91.90% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 8.10% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 75753DC0030013 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | District of Columbia | ||||||||||||||||||
| Health Insurance Issuer | Optimum Choice, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 75753DC0030013-01 | ||||||||||||||||||
| 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 OCI Platinum 250 Health Insurance Plan Variant 75753DC0030013-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Platinum 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 | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Disease Management Programs Offered | Heart Disease, Diabetes, Pregnancy |
| First Tier Utilization | 100% |
| Formulary ID | DCF004 |
| HIOS Product ID | 75753DC003 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 91.90% |
| Issuer ID | 75753 |
| 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 | 0.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $250 per person | $500 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $250 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Platinum |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | DCN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 75753DC0030013-01 |
| Plan Marketing Name | UHC OCI Platinum 250 |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC OCI Platinum 250 |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $200 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,000 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | DCS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All, except OBGYN and as state mandated |
| Plan ID | 75753DC0030013 |
| 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 | $2500 per person | $5000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $2,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of UHC OCI Platinum 250 Health Insurance Plan, 75753DC0030013
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about UHC OCI Platinum 250, 75753DC0030013 Health Insurance Plan, 75753DC0030013
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Does UHC OCI Platinum 250 Health Insurance Plan, 75753DC0030013 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (75753DC0030013) Health Insurance Plan, Variant (75753DC0030013-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Heart Disease, Diabetes, Pregnancy
Does (75753DC0030013) Health Insurance Plan, Variant (75753DC0030013-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (75753DC0030013) Health Insurance Plan, Variant (75753DC0030013-01) 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 (75753DC0030013) Health Insurance Plan, Variant (75753DC0030013-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Heart Disease, Diabetes, Pregnancy
Does UHC OCI Platinum 250 Health Insurance Plan, Variant (75753DC0030013-01) offer Disease Management Programs for Heart disease?
Yes, the UHC OCI Platinum 250 Health Insurance Plan Variant
75753DC0030013-01 offers Disease
Management Program for Heart disease.
Does UHC OCI Platinum 250 Health Insurance Plan, Variant (75753DC0030013-01) offer Disease Management Programs for Diabetes?
Yes, the UHC OCI Platinum 250 Health Insurance Plan Variant
75753DC0030013-01 offers Disease
Management Program for Diabetes.
Does UHC OCI Platinum 250 Health Insurance Plan, Variant (75753DC0030013-01) offer Disease Management Programs for Pregnancy?
Yes, the UHC OCI Platinum 250 Health Insurance Plan Variant
75753DC0030013-01 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