BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE - 10207VA0430006 Health Insurance Plan

CareFirst BlueChoice, Inc. health insurance plan with the Plan ID 10207VA0430006. The plan is called BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.95% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.05% 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 71.92% (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 28.08% 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 10207VA0430006
Health Insurance Plan Year 2024
State Virginia
Health Insurance Issuer CareFirst BlueChoice, Inc.
Health Insurance Plan Variant 10207VA0430006-01
Provider Network(s) ['VAN003']
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 Virginia 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 - 10207VA0430006-01

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

BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan Variant 10207VA0430006-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.719209733
Business Year 2024
Child-Only Offering Allows Adult-Only
Composite Rating Offered No
CSR Variation Type Standard Silver On Exchange Plan
Dental Only Plan No
Disease Management Programs Offered High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
First Tier Utilization 100%
Formulary ID VAF006
HIOS Product ID 10207VA043
HSA/HRA Employer Contribution No
Import Date 2/12/2024
HSA Eligible Yes
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 71.95%
Issuer ID 10207
Market Coverage SHOP (Small Group)
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID VAN003
Out of Country Coverage Yes
Out of Country Coverage Description Emergencey Services Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Services Only
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 10207VA0430006-01
Plan Marketing Name BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE
Plan Type HMO
Plan Variant Marketing Name BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,654
SBC Scenario, Having a Baby, Copayment $40
SBC Scenario, Having a Baby, Deductible $2,500
SBC Scenario, Having a Baby, Limit $10
SBC Scenario, Having Diabetes, Coinsurance $956
SBC Scenario, Having Diabetes, Copayment $250
SBC Scenario, Having Diabetes, Deductible $2,300
SBC Scenario, Having Diabetes, Limit $0
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 $1,900
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID VAS005
Source Name SERFF
Specialty Drug Maximum Coinsurance $150
Plan ID 10207VA0430006
State Code VA
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 20.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $5800 per person | $5800 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $2,900
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 $7950 per person | $15900 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,950
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 BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, 10207VA0430006

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

Frequently Asked Questions(FAQ) about BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE, 10207VA0430006 Health Insurance Plan, 10207VA0430006

  • Does BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, 10207VA0430006 support Mail Ordering?

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

    • Does (10207VA0430006) Health Insurance Plan, Variant (10207VA0430006-01) 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 (10207VA0430006) Health Insurance Plan, Variant (10207VA0430006-01) have Out Of Country Coverage?

    Yes. Details: Emergencey Services Only

    Does (10207VA0430006) Health Insurance Plan, Variant (10207VA0430006-01) have Out of Service Area Coverage?

    Yes. Details: Emergency Services Only

    Does (10207VA0430006) Health Insurance Plan, Variant (10207VA0430006-01) 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 BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, Variant (10207VA0430006-01) offer Disease Management Programs for Asthma?

    Yes, the BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan Variant 10207VA0430006-01 offers Disease Management Program for Asthma.

    Does BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, Variant (10207VA0430006-01) offer Disease Management Programs for Heart disease?

    Yes, the BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan Variant 10207VA0430006-01 offers Disease Management Program for Heart disease.

    Does BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, Variant (10207VA0430006-01) offer Disease Management Programs for Depression?

    Yes, the BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan Variant 10207VA0430006-01 offers Disease Management Program for Depression.

    Does BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, Variant (10207VA0430006-01) offer Disease Management Programs for Diabetes?

    Yes, the BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan Variant 10207VA0430006-01 offers Disease Management Program for Diabetes.

    Does BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, Variant (10207VA0430006-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan Variant 10207VA0430006-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan, Variant (10207VA0430006-01) offer Disease Management Programs for Low back pain?

    Yes, the BlueChoice HMO HSA/HRA Silver 2900 Med Ded 25 Dent Ded SE Health Insurance Plan Variant 10207VA0430006-01 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