Harvard Pilgrim Healthcare, Inc. health insurance plan with the Plan ID 96667ME0310060. The plan is called Clear Choice HMO Gold 2500.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 100.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 0.00% of the costs of all covered benefits (according to the Issuer).
Health Insurance Plan ID | 96667ME0310060 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Maine | ||||||||||||||||||
Health Insurance Issuer | Harvard Pilgrim Healthcare, Inc. | ||||||||||||||||||
Health Insurance Plan Variant | 96667ME0310060-02 | ||||||||||||||||||
Provider Network(s) | ['MEN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 20 Aug 2024 06:14 GMT). |
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Available Variants of the Health Plan | Standard On Exchange Plan - 96667ME0310060-01 |
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Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 20 Aug 2024 06:14 GMT |
Plan Attribute | Value |
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Business Year | 2023 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Zero Cost Sharing Plan Variation |
Drug EHB Deductible, Combined In/Out of Network, Family | $0 per person | $0 per group |
Drug EHB Deductible, Combined In/Out of Network, Individual | $0 |
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
Drug EHB Deductible, Out of Network, Family | $0 per person | $0 per group |
Drug EHB Deductible, Out of Network, Individual | $0 |
Dental Only Plan | No |
Design Type | Not Applicable |
Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, Weight Loss Programs, Low Back Pain, High Blood Pressure & High Cholesterol |
EHB Percent of Total Premium | 99.71% |
First Tier Utilization | 100% |
Formulary ID | MEF014 |
HIOS Product ID | 96667ME031 |
Import Date | 1/23/2023 |
HSA Eligible | No |
IsItANewPlan | New |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | Yes |
Issuer Actuarial Value | 100.00% |
Issuer ID | 96667 |
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 | $0 per person | $0 per group |
Medical EHB Deductible, Combined In/Out of Network, Individual | $0 |
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
Medical EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
Medical EHB Deductible, Out of Network, Family | $0 per person | $0 per group |
Medical EHB Deductible, Out of Network, Individual | $0 |
Metal Level | Gold |
Multiple In Network Tiers | No |
National Network | No |
Network ID | MEN001 |
Out of Country Coverage | No |
Out of Service Area Coverage | No |
Plan Effective Date | 1/1/2023 |
Plan Expiration Date | 12/31/2050 |
Plan ID (Standard Component ID with Variant) | 96667ME0310060-02 |
Plan Marketing Name | Clear Choice HMO Gold 2500 |
Plan Type | HMO |
Plan Variant Marketing Name | HMO CSR 100 |
QHP/Non QHP | Both |
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 | MES001 |
Source Name | SERFF |
Specialist Requiring a Referral | A Referral is Needed for all Specialist except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers. |
Plan ID | 96667ME0310060 |
State Code | ME |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | $0 per person | $0 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $0 |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $0 per person | $0 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $0 |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $0 per person | $0 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $0 |
Unique Plan Design | Yes |
Version Number | 1 |
Wellness Program Offered | Yes |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Disclaimer: This is based on the import(Date: Tue, 20 Aug 2024 06:14 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