Bronze 60 Performance HMO - 92499CA0020008 Health Insurance Plan

Sharp Health Plan health insurance plan with the Plan ID 92499CA0020008. The plan is called Bronze 60 Performance HMO.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.40% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.60% 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 64.60% (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 35.40% 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 92499CA0020008
Health Insurance Plan Year 2024
State California
Health Insurance Issuer Sharp Health Plan
Health Insurance Plan Variant 92499CA0020008-01
Provider Network(s) ['CAN002']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 GMT).

Providers California 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 - 92499CA0020008-01

Open to Indians below 300% FPL - 92499CA0020008-02

Open to Indians above 300% FPL - 92499CA0020008-03

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 24 Dec 2024 06:21 GMT

Bronze 60 Performance HMO Health Insurance Plan Variant 92499CA0020008-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.645987573
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 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 40.00%
Drug EHB Deductible, In Network (Tier 1), Family $500 per person | $1000 per group
Drug EHB Deductible, In Network (Tier 1), Individual $500
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
Design Type Not Applicable
EHB Percent of Total Premium 99%
First Tier Utilization 100%
Formulary ID CAF001
HIOS Product ID 92499CA002
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer Actuarial Value 64.40%
Issuer ID 92499
Market Coverage Individual
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 40.00%
Medical EHB Deductible, In Network (Tier 1), Family $6300 per person | $12600 per group
Medical EHB Deductible, In Network (Tier 1), Individual $6,300
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 No
Network ID CAN002
Out of Country Coverage No
Out of Service Area Coverage No
Plan Effective Date 1/1/2024
Plan ID (Standard Component ID with Variant) 92499CA0020008-01
Plan Marketing Name Bronze 60 Performance HMO
Plan Type HMO
Plan Variant Marketing Name Bronze 60 Performance HMO
QHP/Non QHP On the Exchange
SBC Scenario, Having a Baby, Coinsurance $2,000
SBC Scenario, Having a Baby, Copayment $500
SBC Scenario, Having a Baby, Deductible $6,300
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $1,200
SBC Scenario, Having Diabetes, Copayment $400
SBC Scenario, Having Diabetes, Deductible $2,100
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,000
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID CAS001
Source Name SERFF
Specialist Requiring a Referral All Except OB
Specialty Drug Maximum Coinsurance $500
Plan ID 92499CA0020008
State Code CA
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 $9100 per person | $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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 Bronze 60 Performance HMO Health Insurance Plan, 92499CA0020008

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

Frequently Asked Questions(FAQ) about Bronze 60 Performance HMO, 92499CA0020008 Health Insurance Plan, 92499CA0020008

  • Does Bronze 60 Performance HMO Health Insurance Plan, 92499CA0020008 support Mail Ordering?

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

  • Does (92499CA0020008) Health Insurance Plan, Variant (92499CA0020008-01) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (92499CA0020008) Health Insurance Plan, Variant (92499CA0020008-01) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

 

Disclaimer: This is based on the import(Date: Tue, 24 Dec 2024 06:21 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