Catastrophic PPO 9450/0/0 - 45127PA0020027 Health Insurance Plan

Capital Advantage Assurance Company health insurance plan with the Plan ID 45127PA0020027. The plan is called Catastrophic PPO 9450/0/0.

Health Insurance Plan ID 45127PA0020027
Health Insurance Plan Year 2024
State Pennsylvania
Health Insurance Issuer Capital Advantage Assurance Company
Health Insurance Plan Variant 45127PA0020027-01
Provider Network(s) ['PAN006']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 GMT).

Providers Pennsylvania 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 - 45127PA0020027-01

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 17 Dec 2024 06:12 GMT

Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan Variant 45127PA0020027-01 Attributes

Plan Attribute Value
Begin Primary Care Deductible Coinsurance After Number Of Copays 4
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Catastrophic On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Pregnancy, Depression, Diabetes, Heart Disease, Asthma
EHB Percent of Total Premium 100%
First Tier Utilization 100%
Formulary ID PAF001
HIOS Product ID 45127PA002
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 45127
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Catastrophic
Multiple In Network Tiers No
National Network Yes
Network ID PAN006
Out of Country Coverage Yes
Out of Country Coverage Description Out of Country services are covered in accordance with your benefit contract. Certain services may not be covered.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Out of Service Area services are covered in accordance with your benefit contract. Certain services may not be covered.
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 45127PA0020027-01
Plan Marketing Name Catastrophic PPO 9450/0/0
Plan Type PPO
Plan Variant Marketing Name Catastrophic PPO 9450/0/0 + Catastrophic + PPO
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $9,450
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,300
SBC Scenario, Having Diabetes, Limit $30
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 PAS004
Source Name SERFF
Plan ID 45127PA0020027
State Code PA
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 $9450 per person | $18900 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,450
TEHBDedOutofNetFamily $9450 per person | $18900 per group
Combined Medical and Drug EHB Deductible, Out of Network, Individual $9,450
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), Out of Network, Family $10000 per person | $20000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $10,000
Unique Plan Design No
Version Number 1
Wellness Program Offered No

Copay & Coinsurance of Catastrophic PPO 9450/0/0 Health Insurance Plan, 45127PA0020027

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

Frequently Asked Questions(FAQ) about Catastrophic PPO 9450/0/0, 45127PA0020027 Health Insurance Plan, 45127PA0020027

  • Does Catastrophic PPO 9450/0/0 Health Insurance Plan, 45127PA0020027 support Mail Ordering?

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

    • Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, Depression, Diabetes, Heart Disease, Asthma

    Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) have Out Of Country Coverage?

    Yes. Details: Out of Country services are covered in accordance with your benefit contract. Certain services may not be covered.

    Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) have Out of Service Area Coverage?

    Yes. Details: Out of Service Area services are covered in accordance with your benefit contract. Certain services may not be covered.

    Does (45127PA0020027) Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, Depression, Diabetes, Heart Disease, Asthma

    Does Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Asthma?

    Yes, the Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan Variant 45127PA0020027-01 offers Disease Management Program for Asthma.

    Does Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Heart disease?

    Yes, the Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan Variant 45127PA0020027-01 offers Disease Management Program for Heart disease.

    Does Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Depression?

    Yes, the Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan Variant 45127PA0020027-01 offers Disease Management Program for Depression.

    Does Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Diabetes?

    Yes, the Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan Variant 45127PA0020027-01 offers Disease Management Program for Diabetes.

    Does Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan, Variant (45127PA0020027-01) offer Disease Management Programs for Pregnancy?

    Yes, the Catastrophic PPO 9450/0/0 + Catastrophic + PPO Health Insurance Plan Variant 45127PA0020027-01 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 17 Dec 2024 06:12 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