BCBSVT Bronze Plan - 13627VT0320004 Health Insurance Plan
Blue Cross and Blue Shield of Vermont health insurance plan with the Plan ID 13627VT0320004. The plan is called BCBSVT Bronze Plan.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 62.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 38.00% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 13627VT0320004 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Vermont | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross and Blue Shield of Vermont | ||||||||||||||||||
| Health Insurance Plan Variant | 13627VT0320004-01 | ||||||||||||||||||
| Provider Network(s) | ['VTN001'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
BCBSVT Bronze Plan Health Insurance Plan Variant 13627VT0320004-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze On Exchange Plan |
| 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 | 50.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $1100 per person | $2200 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $1,100 |
| 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 |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Diabetes, Heart Disease, Asthma |
| First Tier Utilization | 100% |
| Formulary ID | VTF008 |
| HIOS Product ID | 13627VT032 |
| HSA/HRA Employer Contribution | No |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 62.00% |
| Issuer ID | 13627 |
| Market Coverage | SHOP (Small Group) |
| 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 | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $6450 per person | $12900 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $6,450 |
| 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 | No |
| National Network | Yes |
| Network ID | VTN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | All members traveling outside the U.S. have access to the BlueCard Worldwide program. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Members may use preferred providers nationally through the BlueCard network. |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 13627VT0320004-01 |
| Plan Marketing Name | BCBSVT Bronze Plan |
| Plan Type | EPO |
| Plan Variant Marketing Name | BCBSVT Bronze Plan |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $2,550 |
| SBC Scenario, Having a Baby, Copayment | $460 |
| SBC Scenario, Having a Baby, Deductible | $6,450 |
| SBC Scenario, Having a Baby, Limit | $50 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,250 |
| SBC Scenario, Having Diabetes, Deductible | $1,930 |
| 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 | $2,630 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | VTS001 |
| Source Name | SERFF |
| Plan ID | 13627VT0320004 |
| State Code | VT |
| 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 | $6,450 |
| 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 | Yes |
Copay & Coinsurance of BCBSVT Bronze Plan Health Insurance Plan, 13627VT0320004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about BCBSVT Bronze Plan, 13627VT0320004 Health Insurance Plan, 13627VT0320004
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Does BCBSVT Bronze Plan Health Insurance Plan, 13627VT0320004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (13627VT0320004) Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs?
Does (13627VT0320004) Health Insurance Plan, Variant (13627VT0320004-01) have Out Of Country Coverage?
Does (13627VT0320004) Health Insurance Plan, Variant (13627VT0320004-01) have Out of Service Area Coverage?
Does (13627VT0320004) Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs?
Does BCBSVT Bronze Plan Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs for Asthma?
Does BCBSVT Bronze Plan Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs for Heart disease?
Does BCBSVT Bronze Plan Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs for Depression?
Does BCBSVT Bronze Plan Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs for Diabetes?
Does BCBSVT Bronze Plan Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does BCBSVT Bronze Plan Health Insurance Plan, Variant (13627VT0320004-01) offer Disease Management Programs for Pregnancy?
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