Anthem Bronze Pathway HMO 5650 Rx Copay $0 Select Drugs - 76680CO0220020 Health Insurance Plan
HMO Colorado, Inc. health insurance plan with the Plan ID 76680CO0220020. The plan is called Anthem Bronze Pathway HMO 5650 Rx Copay $0 Select Drugs.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 63.80% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 36.20% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 66.16% (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 33.84% 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 | 76680CO0220020 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Colorado | ||||||||||||||||||
| Health Insurance Issuer | HMO Colorado, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 76680CO0220020-03 | ||||||||||||||||||
| Provider Network(s) | ['CON005'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 76680CO0220020-01 |
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| Last Plan Update Date | Fri, 31 May 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan Variant 76680CO0220020-03 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.661577237 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 2 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Limited Cost Sharing Plan Variation |
| 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 | 40.00% |
| 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, In Network (Tier 2), Default Coinsurance | 40.00% |
| Drug EHB Deductible, In Network (Tier 2), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 2), 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 |
| Design Type | Not Applicable |
| Disease Management Programs Offered | High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 56% |
| Formulary ID | COF129 |
| HIOS Product ID | 76680CO022 |
| Import Date | 5/31/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 63.80% |
| Issuer ID | 76680 |
| 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 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 | 40.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $5650 per person | $11300 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $5,650 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 40.00% |
| Medical EHB Deductible, In Network (Tier 2), Family | $5650 per person | $11300 per group |
| Medical EHB Deductible, In Network (Tier 2), Individual | $5,650 |
| 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 | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | CON005 |
| Out of Country Coverage | No |
| Out of Country Coverage Description | Urgent/Emergency Coverage Only |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | TRAD/PAR network |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 76680CO0220020-03 |
| Plan Marketing Name | Anthem Bronze Pathway HMO 5650 Rx Copay $0 Select Drugs |
| Plan Type | HMO |
| Plan Variant Marketing Name | Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,800 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $5,650 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,900 |
| SBC Scenario, Having Diabetes, Deductible | $900 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $10 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 44% |
| Service Area ID | COS001 |
| Source Name | SERFF |
| Plan ID | 76680CO0220020 |
| State Code | CO |
| 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 | $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), In Network (Tier 2), Family | $9450 per person | $18900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $9,450 |
| 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 Anthem Bronze Pathway HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, 76680CO0220020
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Anthem Bronze Pathway HMO 5650 Rx Copay $0 Select Drugs, 76680CO0220020 Health Insurance Plan, 76680CO0220020
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Does Anthem Bronze Pathway HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, 76680CO0220020 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (76680CO0220020) Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs?
Does (76680CO0220020) Health Insurance Plan, Variant (76680CO0220020-03) have Out Of Country Coverage?
Does (76680CO0220020) Health Insurance Plan, Variant (76680CO0220020-03) have Out of Service Area Coverage?
Does (76680CO0220020) Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs?
Does Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs for Asthma?
Does Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs for Heart disease?
Does Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs for Depression?
Does Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs for Diabetes?
Does Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Anthem Bronze Pathway X HMO 5650 Rx Copay $0 Select Drugs Health Insurance Plan, Variant (76680CO0220020-03) offer Disease Management Programs for Low back pain?
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