Choice Gold Alternative POS - 76962CT0030001 Health Insurance Plan
ConnectiCare Benefits Inc. health insurance plan with the Plan ID 76962CT0030001. The plan is called Choice Gold Alternative POS.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.18% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.82% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 76962CT0030001 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Connecticut | ||||||||||||||||||
| Health Insurance Issuer | ConnectiCare Benefits Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 76962CT0030001-01 | ||||||||||||||||||
| Provider Network(s) | ['CTN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 26 Nov 2024 06:27 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 76962CT0030001-01 |
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| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 26 Nov 2024 06:27 GMT |
Choice Gold Alternative POS Health Insurance Plan Variant 76962CT0030001-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold 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 | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $75 per person | $150 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $75 |
| Drug EHB Deductible, Out of Network, Family | $500 per person | $1000 per group |
| Drug EHB Deductible, Out of Network, Individual | $500 |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 99% |
| First Tier Utilization | 100% |
| Formulary ID | CTF002 |
| HIOS Product ID | 76962CT003 |
| 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 | 78.18% |
| Issuer ID | 76962 |
| 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 | 30.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $2000 per person | $4000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| Medical EHB Deductible, Out of Network, Family | $7000 per person | $14000 per group |
| Medical EHB Deductible, Out of Network, Individual | $7,000 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | CTN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 76962CT0030001-01 |
| Plan Marketing Name | Choice Gold Alternative POS |
| Plan Type | POS |
| Plan Variant Marketing Name | Choice Gold Alternative POS |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,000 |
| SBC Scenario, Having a Baby, Copayment | $200 |
| SBC Scenario, Having a Baby, Deductible | $2,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $900 |
| SBC Scenario, Having Diabetes, Deductible | $800 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $100 |
| 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 | CTS001 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $150 |
| Plan ID | 76962CT0030001 |
| State Code | CT |
| 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 | $8300 per person | $16600 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,300 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $12000 per person | $24000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $12,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Choice Gold Alternative POS Health Insurance Plan, 76962CT0030001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Choice Gold Alternative POS, 76962CT0030001 Health Insurance Plan, 76962CT0030001
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Does Choice Gold Alternative POS Health Insurance Plan, 76962CT0030001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (76962CT0030001) Health Insurance Plan, Variant (76962CT0030001-01) offer Disease Management Programs?
Does (76962CT0030001) Health Insurance Plan, Variant (76962CT0030001-01) have Out Of Country Coverage?
Does (76962CT0030001) Health Insurance Plan, Variant (76962CT0030001-01) have Out of Service Area Coverage?
Does (76962CT0030001) Health Insurance Plan, Variant (76962CT0030001-01) offer Disease Management Programs?
Does Choice Gold Alternative POS Health Insurance Plan, Variant (76962CT0030001-01) offer Disease Management Programs for Asthma?
Does Choice Gold Alternative POS Health Insurance Plan, Variant (76962CT0030001-01) offer Disease Management Programs for Heart disease?
Does Choice Gold Alternative POS Health Insurance Plan, Variant (76962CT0030001-01) offer Disease Management Programs for Diabetes?
Disclaimer: This is based on the import(Date: Tue, 26 Nov 2024 06:27 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