Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental - 41046NY0010010 Health Insurance Plan
Empire BlueCross BlueShield HealthPlus health insurance plan with the Plan ID 41046NY0010010. The plan is called Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental.
| Health Insurance Plan ID | 41046NY0010010 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | New York | ||||||||||||||||||
| Health Insurance Issuer | Empire BlueCross BlueShield HealthPlus | ||||||||||||||||||
| Health Insurance Plan Variant | 41046NY0010010-01 | ||||||||||||||||||
| Provider Network(s) | ['NYN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant 41046NY0010010-01 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 | High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 99% |
| First Tier Utilization | 100% |
| Formulary ID | NYF107 |
| HIOS Product ID | 41046NY001 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 41046 |
| 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 | NYN001 |
| Out of Country Coverage | No |
| Out of Country Coverage Description | 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) | 41046NY0010010-01 |
| Plan Marketing Name | Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental |
| Plan Type | HMO |
| Plan Variant Marketing Name | Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental |
| 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 | $4,700 |
| 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 | NYS002 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All specialists require referral with the exception of OB/GYN |
| Plan ID | 41046NY0010010 |
| State Code | NY |
| 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 | $9450 per person | $18900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,450 |
| TEHBDedOutofNetFamily | per person not applicable | per group 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 | $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 | 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 Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, 41046NY0010010
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental, 41046NY0010010 Health Insurance Plan, 41046NY0010010
-
Does Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, 41046NY0010010 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (41046NY0010010) Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs?
Yes, and here is the list of available programs: High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does (41046NY0010010) Health Insurance Plan, Variant (41046NY0010010-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan). Details: Emergency Coverage Only
Does (41046NY0010010) Health Insurance Plan, Variant (41046NY0010010-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan). Details: TRAD/PAR network
Does (41046NY0010010) Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs?
Yes, and here is the list of available programs: High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs for Asthma?
Yes, the Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010010-01 offers Disease
Management Program for Asthma.
Does Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs for Heart disease?
Yes, the Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010010-01 offers Disease
Management Program for Heart disease.
Does Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs for Depression?
Yes, the Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010010-01 offers Disease
Management Program for Depression.
Does Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs for Diabetes?
Yes, the Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010010-01 offers Disease
Management Program for Diabetes.
Does Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010010-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan, Variant (41046NY0010010-01) offer Disease Management Programs for Low back pain?
Yes, the Anthem Gatekeeper X, Catastrophic, ST, INN, Individual Network, Pediatric Dental Health Insurance Plan Variant
41046NY0010010-01 offers Disease
Management Program 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