Bronze 60 HDHP Ambetter PPO - 67138CA0700025 Health Insurance Plan
Health Net of California health insurance plan with the Plan ID 67138CA0700025. The plan is called Bronze 60 HDHP Ambetter PPO.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.94% (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 35.06% 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 | 67138CA0700025 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | California | ||||||||||||||||||
| Health Insurance Issuer | Health Net of California | ||||||||||||||||||
| Health Insurance Plan Variant | 67138CA0700025-03 | ||||||||||||||||||
| Provider Network(s) | ['CAN003'] | ||||||||||||||||||
| 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 - 67138CA0700025-01 |
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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 |
Bronze 60 HDHP Ambetter PPO AI-AN Health Insurance Plan Variant 67138CA0700025-03 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.649419405 |
| 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 |
| EHB Percent of Total Premium | 99% |
| First Tier Utilization | 100% |
| Formulary ID | CAF006 |
| HIOS Product ID | 67138CA070 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 67138 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | CAN003 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 67138CA0700025-03 |
| Plan Marketing Name | Bronze 60 HDHP Ambetter PPO |
| Plan Type | PPO |
| Plan Variant Marketing Name | Bronze 60 HDHP Ambetter PPO AI-AN |
| QHP/Non QHP | On the Exchange |
| 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 | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| 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 | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | CAS001 |
| Source Name | SERFF |
| Plan ID | 67138CA0700025 |
| State Code | CA |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | $32050 per person | $64100 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $32,050 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | $21150 per person | $42300 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $21,150 |
| 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 | $7050 per person | $14100 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,050 |
| TEHBDedOutofNetFamily | $14100 per person | $28200 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $14,100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $7050 per person | $14100 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,050 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $25000 per person | $50000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $25,000 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Bronze 60 HDHP Ambetter PPO Health Insurance Plan, 67138CA0700025
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Bronze 60 HDHP Ambetter PPO, 67138CA0700025 Health Insurance Plan, 67138CA0700025
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Does Bronze 60 HDHP Ambetter PPO Health Insurance Plan, 67138CA0700025 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (67138CA0700025) Health Insurance Plan, Variant (67138CA0700025-03) have Out Of Country Coverage?
Does (67138CA0700025) Health Insurance Plan, Variant (67138CA0700025-03) have Out of Service Area Coverage?
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