WellFirst by Medica Expanded Bronze Standard - 47840MO0010017 Health Insurance Plan
Medica Central Insurance Company health insurance plan with the Plan ID 47840MO0010017. The plan is called WellFirst by Medica Expanded Bronze Standard.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.81% (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 36.19% 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 | 47840MO0010017 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Missouri | ||||||||||||||||||
| Health Insurance Issuer | Medica Central Insurance Company | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 47840MO0010017-00 | ||||||||||||||||||
| Provider Network(s) | ['MON001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Sep 2025 15:17 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | Standard Off Exchange Plan - 47840MO0010017-00 Standard On Exchange Plan - 47840MO0010017-01 |
||||||||||||||||||
| Last Plan Update Date | Tue, 31 Dec 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Sep 2025 15:17 GMT |
Benefits of WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, 47840MO0010017-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan nan |
NO | ||
| Chemotherapy
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Chiropractic Care
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | $50.00 |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Dental Check-Up for Children
Exclusions: nan nan |
NO | ||
| Diabetes Education
Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | No Charge |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Durable Medical Equipment
Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Emergency Room Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Gender Affirming Care
Exclusions: nan nan |
NO | ||
| Generic Drugs
Exclusions: nan nan |
YES | $25.00 |
100.00% |
| Habilitation Services
Limit: 40.0 Visit(s) per Benefit Period Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | $50.00 |
100.00% |
| Hearing Aids
Limit: 2.0 Item(s) per 3 Years Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Home Health Care Services
Limit: 100.0 Visit(s) per Benefit Period Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Hospice Services
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan nan |
NO | ||
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | $50.00 |
100.00% |
| Non-Preferred Brand Drugs
Exclusions: nan nan |
YES | $100.00 Copay after deductible |
100.00% |
| Nutritional Counseling
Exclusions: nan See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan nan |
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan nan |
YES | $50.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 40.0 Visit(s) per Benefit Period Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | $50.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Preferred Brand Drugs
Exclusions: nan nan |
YES | $50.00 Copay after deductible |
100.00% |
| Prenatal and Postnatal Care
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan Virtual visits are unlimited with a $0 copayment when provided by a designated in-network virtual care provider for non-urgent medical symptoms for common illnesses. |
YES | $50.00 |
100.00% |
| Private-Duty Nursing
Limit: 82.0 Visit(s) per Benefit Period Exclusions: nan See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Prosthetic Devices
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Radiation
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Reconstructive Surgery
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 20.0 Visit(s) per Benefit Period Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | $50.00 |
100.00% |
| Rehabilitative Speech Therapy
Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | $50.00 |
100.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Benefit Period Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | $50.00 |
100.00% |
| Routine Foot Care
Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Skilled Nursing Facility
Limit: 150.0 Days per Benefit Period Exclusions: See policy or plan document for additional benefit exclusions. See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $100.00 |
100.00% |
| Specialty Drugs
Exclusions: nan nan |
YES | $500.00 Copay after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | $50.00 |
100.00% |
| Transplant
Exclusions: See policy or plan document for additional benefit exclusions. nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan See policy or plan document for additional benefit explanation. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Urgent Care Centers or Facilities
Exclusions: nan nan |
YES | $75.00 |
$75.00 |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
WellFirst by Medica Expanded Bronze Standard Health Insurance Plan Variant 47840MO0010017-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.638091065338329 |
| 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 Bronze Off Exchange Plan |
| Dental Only Plan | No |
| Design Type | Design 1 |
| Disease Management Programs Offered | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
| EHB Percent of Total Premium | 1.0 |
| First Tier Utilization | 100% |
| Formulary ID | MOF003 |
| Formulary URL | URL |
| HIOS Product ID | 47840MO001 |
| Import Date | 2024-12-31 00:02:01 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 47840 |
| Issuer Marketplace Marketing Name | Medica |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MON001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency Only |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 47840MO0010017-00 |
| Plan Level Exclusions | See policy or plan document for additional excluded services. |
| Plan Marketing Name | WellFirst by Medica Expanded Bronze Standard |
| Plan Type | EPO |
| Plan Variant Marketing Name | WellFirst by Medica Expanded Bronze Standard |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,700 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $7,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $400 |
| SBC Scenario, Having Diabetes, Deductible | $4,400 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MOS001 |
| Source Name | HIOS |
| Plan ID | 47840MO0010017 |
| State Code | MO |
| 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 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person 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 | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $15000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $7500 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,500 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| 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 | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, 47840MO0010017
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about WellFirst by Medica Expanded Bronze Standard, 47840MO0010017 Health Insurance Plan, 47840MO0010017
-
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, 47840MO0010017 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (47840MO0010017) Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs?
Does (47840MO0010017) Health Insurance Plan, Variant (47840MO0010017-00) have Out Of Country Coverage?
Does (47840MO0010017) Health Insurance Plan, Variant (47840MO0010017-00) have Out of Service Area Coverage?
Does (47840MO0010017) Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs?
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs for Asthma?
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs for Heart disease?
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs for Depression?
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs for Diabetes?
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs for Low back pain?
Does WellFirst by Medica Expanded Bronze Standard Health Insurance Plan, Variant (47840MO0010017-00) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 16 Sep 2025 15:17 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