Voyager Silver HSA 5100 - 10091OR0700005 Health Insurance Plan

PacificSource Health Plans health insurance plan with the Plan ID 10091OR0700005. The plan is called Voyager Silver HSA 5100.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.92% (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 28.08% 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 10091OR0700005
Health Insurance Plan Year 2024
State Oregon
Health Insurance Issuer PacificSource Health Plans
Health Insurance Plan Variant 10091OR0700005-01
Provider Network(s) ['ORN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT).

Providers Oregon All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard On Exchange Plan - 10091OR0700005-01

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Voyager Silver HSA 5100 Health Insurance Plan Variant 10091OR0700005-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.719211218
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered Yes
CSR Variation Type Standard Silver On Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Pregnancy, Diabetes, Heart Disease, Asthma
First Tier Utilization 100%
Formulary ID ORF014
HIOS Product ID 10091OR070
HSA/HRA Employer Contribution No
Import Date 2/12/2024
HSA Eligible Yes
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 10091
Market Coverage SHOP (Small Group)
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network Yes
Network ID ORN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Care Services Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description In and out-of-network providers
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 10091OR0700005-01
Plan Marketing Name Voyager Silver HSA 5100
Plan Type PPO
Plan Variant Marketing Name Voyager Silver HSA 5100
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $5,100
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,100
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ORS001
Source Name SERFF
Plan ID 10091OR0700005
State Code OR
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
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family per person not applicable | per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $5100 per person | $10200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,100
TEHBDedOutofNetFamily $7500 per person | $15000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Individual $7,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $5100 per person | $10200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $5,100
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $11250 per person | $22500 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $11,250
Unique Plan Design No
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of Voyager Silver HSA 5100 Health Insurance Plan, 10091OR0700005

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

Frequently Asked Questions(FAQ) about Voyager Silver HSA 5100, 10091OR0700005 Health Insurance Plan, 10091OR0700005

  • Does Voyager Silver HSA 5100 Health Insurance Plan, 10091OR0700005 support Mail Ordering?

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

  • Does (10091OR0700005) Health Insurance Plan, Variant (10091OR0700005-01) offer Disease Management Programs?

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

    Does (10091OR0700005) Health Insurance Plan, Variant (10091OR0700005-01) have Out Of Country Coverage?

    Yes. Details: Emergency Care Services Only

    Does (10091OR0700005) Health Insurance Plan, Variant (10091OR0700005-01) have Out of Service Area Coverage?

    Yes. Details: In and out-of-network providers

    Does (10091OR0700005) Health Insurance Plan, Variant (10091OR0700005-01) offer Disease Management Programs?

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

    Does Voyager Silver HSA 5100 Health Insurance Plan, Variant (10091OR0700005-01) offer Disease Management Programs for Asthma?

    Yes, the Voyager Silver HSA 5100 Health Insurance Plan Variant 10091OR0700005-01 offers Disease Management Program for Asthma.

    Does Voyager Silver HSA 5100 Health Insurance Plan, Variant (10091OR0700005-01) offer Disease Management Programs for Heart disease?

    Yes, the Voyager Silver HSA 5100 Health Insurance Plan Variant 10091OR0700005-01 offers Disease Management Program for Heart disease.

    Does Voyager Silver HSA 5100 Health Insurance Plan, Variant (10091OR0700005-01) offer Disease Management Programs for Diabetes?

    Yes, the Voyager Silver HSA 5100 Health Insurance Plan Variant 10091OR0700005-01 offers Disease Management Program for Diabetes.

    Does Voyager Silver HSA 5100 Health Insurance Plan, Variant (10091OR0700005-01) offer Disease Management Programs for Pregnancy?

    Yes, the Voyager Silver HSA 5100 Health Insurance Plan Variant 10091OR0700005-01 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 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