Blue Community Silver HMO℠ 203 - 75605NM0390110 Health Insurance Plan
Blue Cross Blue Shield of New Mexico health insurance plan with the Plan ID 75605NM0390110. The plan is called Blue Community Silver HMO℠ 203.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.59% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.41% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 75605NM0390110 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | New Mexico | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross Blue Shield of New Mexico | ||||||||||||||||||
| Health Insurance Plan Variant | 75605NM0390110-03 | ||||||||||||||||||
| Provider Network(s) | ['NMN002'] | ||||||||||||||||||
| 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 - 75605NM0390110-01 Open to Indians below 300% FPL - 75605NM0390110-02 Open to Indians above 300% FPL - 75605NM0390110-03 73% AV Silver Plan - 75605NM0390110-04 |
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| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan Variant 75605NM0390110-03 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Limited Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 85% |
| Formulary ID | NMF020 |
| HIOS Product ID | 75605NM039 |
| 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 | 70.59% |
| Issuer ID | 75605 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | NMN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage outside our service area is available for Emergency and Urgent Care services only. |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 75605NM0390110-03 |
| Plan Marketing Name | Blue Community Silver HMO℠ 203 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Native American Blue Community Silver HMO℠ 203 - LCS |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| 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 | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 15% |
| Service Area ID | NMS042 |
| Source Name | SERFF |
| Plan ID | 75605NM0390110 |
| State Code | NM |
| 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 | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $1800 per person | $3600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,800 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family | $1800 per person | $3600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $1,800 |
| 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), 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 Blue Community Silver HMO℠ 203 Health Insurance Plan, 75605NM0390110
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Blue Community Silver HMO℠ 203, 75605NM0390110 Health Insurance Plan, 75605NM0390110
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Does Blue Community Silver HMO℠ 203 Health Insurance Plan, 75605NM0390110 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (75605NM0390110) Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs?
Does (75605NM0390110) Health Insurance Plan, Variant (75605NM0390110-03) have Out Of Country Coverage?
Does (75605NM0390110) Health Insurance Plan, Variant (75605NM0390110-03) have Out of Service Area Coverage?
Does (75605NM0390110) Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs?
Does Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs for Asthma?
Does Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs for Heart disease?
Does Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs for Depression?
Does Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs for Diabetes?
Does Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan, Variant (75605NM0390110-03) offer Disease Management Programs for Low back pain?
Does Native American Blue Community Silver HMO℠ 203 - LCS Health Insurance Plan, Variant (75605NM0390110-03) 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