ACCESS CATASTROPHIC - 38128ID0160005 Health Insurance Plan

Mountain Health Cooperative health insurance plan with the Plan ID 38128ID0160005. The plan is called ACCESS CATASTROPHIC .

Health Insurance Plan ID 38128ID0160005
Health Insurance Plan Year 2024
State Idaho
Health Insurance Issuer Mountain Health Cooperative
Health Insurance Plan Variant 38128ID0160005-01
Provider Network(s) ['IDN003']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT).

Providers Idaho 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 - 38128ID0160005-01

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Thu, 21 Nov 2024 00:44 GMT

ACCESS CATASTROPHIC Health Insurance Plan Variant 38128ID0160005-01 Attributes

Plan Attribute Value
Begin Primary Care Deductible Coinsurance After Number Of Copays 3
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Catastrophic On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Diabetes, Asthma
EHB Percent of Total Premium 100%
First Tier Utilization 100%
Formulary ID IDF003
HIOS Product ID 38128ID016
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 38128
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Catastrophic
Multiple In Network Tiers No
National Network No
Network ID IDN003
Out of Country Coverage Yes
Out of Country Coverage Description Emergent Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergent Only
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 38128ID0160005-01
Plan Marketing Name ACCESS CATASTROPHIC
Plan Type POS
Plan Variant Marketing Name ACCESS CATASTROPHIC
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $9,450
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,400
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 IDS002
Source Name SERFF
Plan ID 38128ID0160005
State Code ID
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family $36750 per person | $73500 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $36,750
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family $36750 per person | $73500 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $36,750
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 $9450 per person | $18900 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,450
TEHBDedOutofNetFamily $27300 per person | $54600 per group
Combined Medical and Drug EHB Deductible, Out of Network, Individual $27,300
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $9450 per person | $18900 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,450
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $27300 per person | $54600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $27,300
Unique Plan Design No
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of ACCESS CATASTROPHIC Health Insurance Plan, 38128ID0160005

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

Frequently Asked Questions(FAQ) about ACCESS CATASTROPHIC , 38128ID0160005 Health Insurance Plan, 38128ID0160005

  • Does ACCESS CATASTROPHIC Health Insurance Plan, 38128ID0160005 support Mail Ordering?

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

    • Does (38128ID0160005) Health Insurance Plan, Variant (38128ID0160005-01) offer Disease Management Programs?

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

    Does (38128ID0160005) Health Insurance Plan, Variant (38128ID0160005-01) have Out Of Country Coverage?

    Yes. Details: Emergent Only

    Does (38128ID0160005) Health Insurance Plan, Variant (38128ID0160005-01) have Out of Service Area Coverage?

    Yes. Details: Emergent Only

    Does (38128ID0160005) Health Insurance Plan, Variant (38128ID0160005-01) offer Disease Management Programs?

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

    Does ACCESS CATASTROPHIC Health Insurance Plan, Variant (38128ID0160005-01) offer Disease Management Programs for Asthma?

    Yes, the ACCESS CATASTROPHIC Health Insurance Plan Variant 38128ID0160005-01 offers Disease Management Program for Asthma.

    Does ACCESS CATASTROPHIC Health Insurance Plan, Variant (38128ID0160005-01) offer Disease Management Programs for Diabetes?

    Yes, the ACCESS CATASTROPHIC Health Insurance Plan Variant 38128ID0160005-01 offers Disease Management Program for Diabetes.

 

Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 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