Bronze 9000 SAHA Connect Deductible-First - 61589ID2350131 Health Insurance Plan

Blue Cross of Idaho Health Service, Inc. health insurance plan with the Plan ID 61589ID2350131. The plan is called Bronze 9000 SAHA Connect Deductible-First.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 61.49% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 38.51% 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 61.04% (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 38.96% 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 61589ID2350131
Health Insurance Plan Year 2024
State Idaho
Health Insurance Issuer Blue Cross of Idaho Health Service, Inc.
Health Insurance Plan Variant 61589ID2350131-01
Provider Network(s) ['IDN009']
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 Idaho 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 - 61589ID2350131-01

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

Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan Variant 61589ID2350131-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.610350587
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze On Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma
First Tier Utilization 100%
Formulary ID IDF009
HIOS Product ID 61589ID235
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 61.49%
Issuer ID 61589
Market Coverage SHOP (Small Group)
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Bronze
Multiple In Network Tiers No
National Network Yes
Network ID IDN009
Out of Country Coverage Yes
Out of Country Coverage Description The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services. Except as provided by the federal No Surprises Act.
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 61589ID2350131-01
Plan Marketing Name Bronze 9000 SAHA Connect Deductible-First
Plan Type POS
Plan Variant Marketing Name Bronze 9000 SAHA Connect Deductible-First
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $9,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $370
SBC Scenario, Having Diabetes, Deductible $4,420
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 $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID IDS001
Source Name SERFF
Plan ID 61589ID2350131
State Code ID
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 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $9000 per person | $18000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,000
TEHBDedOutofNetFamily $18000 per person | $36000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Individual $18,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $9000 per person | $18000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $18000 per person | $36000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $18,000
Unique Plan Design Yes
Version Number 1
Wellness Program Offered No

Copay & Coinsurance of Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, 61589ID2350131

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

Frequently Asked Questions(FAQ) about Bronze 9000 SAHA Connect Deductible-First, 61589ID2350131 Health Insurance Plan, 61589ID2350131

  • Does Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, 61589ID2350131 support Mail Ordering?

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

    • Does (61589ID2350131) Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma

    Does (61589ID2350131) Health Insurance Plan, Variant (61589ID2350131-01) have Out Of Country Coverage?

    Yes. Details: The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply.

    Does (61589ID2350131) Health Insurance Plan, Variant (61589ID2350131-01) have Out of Service Area Coverage?

    Yes. Details: In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services. Except as provided by the federal No Surprises Act.

    Does (61589ID2350131) Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma

    Does Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs for Asthma?

    Yes, the Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan Variant 61589ID2350131-01 offers Disease Management Program for Asthma.

    Does Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs for Heart disease?

    Yes, the Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan Variant 61589ID2350131-01 offers Disease Management Program for Heart disease.

    Does Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs for Diabetes?

    Yes, the Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan Variant 61589ID2350131-01 offers Disease Management Program for Diabetes.

    Does Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan Variant 61589ID2350131-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs for Pregnancy?

    Yes, the Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan Variant 61589ID2350131-01 offers Disease Management Program for Pregnancy.

    Does Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan, Variant (61589ID2350131-01) offer Disease Management Programs for Weight loss programs?

    Yes, the Bronze 9000 SAHA Connect Deductible-First Health Insurance Plan Variant 61589ID2350131-01 offers Disease Management Program for Weight loss programs.

 

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