Dean Health Plan health insurance plan with the Plan ID 38345WI0080032. The plan is called Dean Focus Network Silver HSA-E HDHP 3550X.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 94.63% (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 5.37% 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 | 38345WI0080032 | ||||||||||||||||||
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Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Wisconsin | ||||||||||||||||||
Health Insurance Issuer | Dean Health Plan | ||||||||||||||||||
Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 38345WI0080032-06 | ||||||||||||||||||
Provider Network(s) | DEANHEALTHPLANFOCUS | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 27 Aug 2024 05:58 GMT). |
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Available Variants of the Health Plan | Standard Off Exchange Plan - 38345WI0080032-00 Standard On Exchange Plan - 38345WI0080032-01 Open to Indians below 300% FPL - 38345WI0080032-02 Open to Indians above 300% FPL - 38345WI0080032-03 73% AV Silver Plan - 38345WI0080032-04 |
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Last Plan Update Date | Sat, 18 Nov 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 27 Aug 2024 05:58 GMT |
Benefit | Covered | In Network | Out Of Network |
---|---|---|---|
Abortion for Which Public Funding is Prohibited
|
NO | ||
Accidental Dental
Exclusions: Surgery performed to correct functional deformities of the mandible or maxilla; correction of malocclusion; orthognathic surgery; orthodontic care, periodontic care or general dental care; tooth damage due to eating, chewing or biting. These benefits are intended for dental treatment needed to remove, repair, replace, restore and/or reposition sound, natural teeth damaged, lost, or removed due to an injury. The term "injured" does not include conditions resulting from eating, chewing or biting. To be eligible for coverage, the services must be medically necessary while you are enrolled under this policy, dental services are received from a Doctor of Dental Surgery or Doctor of Medical Dentistry, and the tooth must meet the definition of "sound, natural tooth". |
YES | 5.00% Coinsurance after deductible |
100.00% |
Acupuncture
|
NO | ||
Allergy Testing
Exclusions: Cytotoxic testing and sublingual antigens associated to allergy testing. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Bariatric Surgery
|
NO | ||
Basic Dental Care - Adult
|
NO | ||
Basic Dental Care - Child
|
NO | ||
Chemotherapy
Intravenous chemotherapy is covered. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Chiropractic Care
Exclusions: Maintenance or long-term therapy. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Cosmetic Surgery
|
NO | ||
Delivery and All Inpatient Services for Maternity Care
Exclusions: Amniocentesis, CVS (Chorionic Villi Sampling), or non-invasive pre-natal testing when performed exclusively for sex determination; birthing classes; Services, drugs, or supplies related to abortions, except when: 1) a woman suffers from a physical disorder, physical injury, or physical illness that would place the woman in danger of death unless an abortion is performed, or 2) the pregnancy is the result of an act of rape or incest; home or intentional out-of-hospital deliveries; maternity services received outside the service area during the last 30 days of the pregnancy, except for emergency or urgent care services; Assisted Reproductive Technology (ART) services, treatment, supplies, and/or procedures for a non-member traditional surrogate or gestational carrier, who is not covered under this policy. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Dental Check-Up for Children
|
NO | ||
Diabetes Education
Exclusions: Educational services, except for diabetic education and diabetic self-management training classes. Diabetic education; diabetic self-management training classes. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Dialysis
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Durable Medical Equipment
Exclusions: Enteral feedings unless they are the sole source of nutrition; however, enteral feedings of standard infant formulas, standard baby food and regular grocery products use in blenderized formulas are excluded regardless of whether they are the sole source of nutrition; medical supplies and durable medical equipment for comfort, personal hygiene and convenience, regardless of medical necessity of such items; home testing and monitoring supplies and related equipment, except as covered by our medical policy; equipment, models or devices that have features over and above what is Medically Necessary (Coverage will be limited to the standard model as determined by Us); non-prescription elastic support or anti-embolism stockings; shoes or foot orthotics not custom-made and purchased over the counter; any durable medical equipment or supplies used for work, athletic, or job enhancement purposes; cranial bands; back-up equipment (a second piece); replacement of durable medical equipment more frequently than every three years, unless defined by our medical policy or mandated by law; replacement of an item that is lost, stolen, or unusable/nonfunctioning because of misuse, abuse, or neglect; items that can be purchased over the counter, unless coverage is required by state or federal law; oral nutrition (oral nutrition is not considered a medical item. We do not cover nutritional support that is taken orally (i.e., by mouth), unless mandated by law or covered under our medical policy for a specific condition); technology devices that are not primarily and customarily used to serve a medical purpose such as desktop computers, portable multi-media players, smart phones, tablet devices and similar items are not considered durable medical equipment. Covers medical supplies and durable medical equipment. Examples include, but are not limited to: wheelchairs, tube feeding nutrition supplies; hospital beds; oxygen and respiratory equipment; walking aids; orthopedic products; urological and ostomy supplies; orthotics and prosthetics; diabetic durable equipment and insulin infusion pumps (Insulin infusion pumps are limited to one pump per contract period and the member must use the pump for 30 days before purchasing.); other medical supplies as determined by us. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Emergency Room Services
|
YES | 5.00% Coinsurance after deductible |
5.00% Coinsurance after deductible |
Emergency Transportation/Ambulance
Exclusions: Non-emergency or non-urgent ground or air ambulance services or transportation, unless the transportation or service is listed as a covered expense or prior authorized by us; Charges for, or in connection with, any other form of travel, unless otherwise stated in this section; Member's condition does not meet medical criteria for ambulance services or transportation; Any ambulance transportation or services initiated for convenience or non-medical reasons. |
YES | 5.00% Coinsurance after deductible |
5.00% Coinsurance after deductible |
Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: Blended segment lenses; intermediate vision lenses; standard progressives; premium progressives; photochromic glass lenses; plastic photosensitive lenses; polarized lenses; standard anti-reflective (AR) coating; premium AR coating. One pair of prescription eyeglasses per year, as follows: glass or plastic lenses; single vision, conventional (lined) bifocal and conventional (lined) trifocal lenses; polycarbonate lenses (monocular or patients with prescriptions greater than a +6.00 or -6.00 diopter); frame; scratch resistant coating; ultraviolet protective coating. One replacement pair of eyeglasses per year. Contact lenses. Benefits for contact lenses are in lieu of your eyeglass lens benefit. If you receive contact lenses, no benefit will be available for eyeglasses until the next contract period. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Gender Affirming Care
|
NO | ||
Generic Drugs
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Habilitation Services
Limit: 60.0 Visit(s) per Year Exclusions: Custodial care; daycare; recreational care; respite care; vocational or life training. Separate 20 visit(s) limit per therapy type per year for Physical, Occupational and Speech Therapy. Habilitative Services and devices are those services and devices that help a person keep, learn, or improve skills and functioning for daily living. Covered expenses include medically necessary physical therapy, occupational therapy and speech therapy, counseling, behavioral health services, and services for developmental delay. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Hearing Aids
Limit: 2.0 Item(s) per 3 Years Exclusions: Batteries and chargers for hearing aids. Hearing aids that are available over-the-counter. Limited to one hearing aid per ear or one set of bilateral hearing aids (both ears) and ear molds, including dispensing fees. Benefits are available per benefit period. The benefit period is 36 consecutive months from the date the benefit is first used. Repairs as medically necessary. The hearing aid must be repaired by/purchased from an authorized provider. Cochlear implants, for children and adults, including procedures for implantation and post-cochlear implant aural therapy. Bone-anchored hearing aids. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Home Health Care Services
Limit: 60.0 Visit(s) per Year Exclusions: Residential care; private duty nursing; home care services provided by a family member or someone who resides with the member; custodial care or any service that is not required to be provided by a skilled/licensed provider. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Hospice Services
Exclusions: Residential care; services provided by volunteers; housekeeping or homemaking services; respite care for more than five consecutive days. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Imaging (CT/PET Scans, MRIs)
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Infertility Treatment
|
NO | ||
Infusion Therapy
Exclusions: A drug or biologic that is not considered medically necessary. Home infusion administered by a family member or someone who resides with a family member. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: Take home drugs and supplies dispensed by the hospital, unless a written prescription is obtained and filled at a network pharmacy; hospital stays that are extended for reasons other than medical necessity; a continued hospital stay, if the attending health care provider has documented that care could effectively be provided in a less acute care setting; separate charges for personal comfort or convenience items. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Inpatient Physician and Surgical Services
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Laboratory Outpatient and Professional Services
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Long-Term/Custodial Nursing Home Care
|
NO | ||
Major Dental Care - Adult
|
NO | ||
Major Dental Care - Child
|
NO | ||
Mental/Behavioral Health Inpatient Services
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Mental/Behavioral Health Outpatient Services
Exclusions: Biofeedback; family counseling for non-medical reasons; wilderness and camp programs, boarding school, academy-vocational programs and group homes; halfway houses; hypnotherapy; long-term or maintenance therapy; marriage counseling; phototherapy. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Non-Preferred Brand Drugs
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Nutritional Counseling
A registered or certified dietitian must give or supervise these services. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
|
NO | ||
Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Outpatient Rehabilitation Services
Limit: 60.0 Visit(s) per Year Exclusions: Vocational rehabilitation, including work hardening programs; hearing therapy for communication delay, therapy for perceptual disorders, intellectual disability and related conditions, and other long-term special therapy, except as specifically listed under habilitative services or autism spectrum disorder section; therapy services such as recreational or educational therapy, physical fitness or exercise programs; services to enhance athletic training or performance; services or treatment received at intermediate care facilities; submaximal stress testing except for members with cardiovascular disease. Separate 20 visit(s) limit per therapy type per year for Physical, Occupational and Speech Therapy. Pulmonary rehab has no visit limits. Cardiac Rehabilitation has no visit limits. These therapy benefits are only for treatment of those conditions that, in the judgment of the attending health care provider, are expected to yield significant patient improvement, as determined by us. Therapists must be licensed and must not live in the patient's home or be a family member. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Outpatient Surgery Physician/Surgical Services
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Preferred Brand Drugs
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Prenatal and Postnatal Care
Exclusions: Amniocentesis, CVS (Chorionic Villi Sampling), or non-invasive pre-natal testing when performed exclusively for sex determination; birthing classes; Services, drugs, or supplies related to abortions, except when: 1) a woman suffers from a physical disorder, physical injury, or physical illness that would place the woman in danger of death unless an abortion is performed, or 2) the pregnancy is the result of an act of rape or incest; home or intentional out-of-hospital deliveries; maternity services received outside the service area during the last 30 days of the pregnancy, except for emergency or urgent care services; Assisted Reproductive Technology (ART) services, treatment, supplies, and/or procedures for a non-member traditional surrogate or gestational carrier, who is not covered under this policy. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Preventive Care/Screening/Immunization
|
YES | 100.00% | |
Primary Care Visit to Treat an Injury or Illness
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Private-Duty Nursing
|
NO | ||
Prosthetic Devices
Exclusions: Medical supplies and durable medical equipment for comfort, personal hygiene and convenience, regardless of medical necessity of such items; home testing and monitoring supplies and related equipment, except as covered by our medical policy; equipment, models or devices that have features over and above what is medically necessary (Coverage will be limited to the standard model as determined by us); non-prescription elastic support or anti-embolism stockings; shoes or foot orthotics not custom-made and purchased over the counter; any durable medical equipment or supplies used for work, athletic, or job enhancement purposes; cranial bands; back-up equipment (a second piece); replacement of durable medical equipment more frequently than every three years, unless defined by our medical policy or mandated by law; replacement of an item that is lost, stolen, or unusable/nonfunctioning because of misuse, abuse, or neglect; items that can be purchased over the counter, unless coverage is required by state or federal law. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Radiation
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Reconstructive Surgery
Exclusions: Non-medically necessary plastic surgery. This limitation does not affect coverage provided for breast reconstruction in connection with a mastectomy. Cosmetic services and procedures, including cosmetic surgery. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 20.0 Visit(s) per Year Exclusions: Vocational rehabilitation, including work hardening programs; hearing therapy for communication delay, therapy for perceptual disorders, intellectual disability and related conditions, and other long-term special therapy, except as specifically listed under habilitative services or autism spectrum disorder section; therapy services such as recreational or educational therapy, physical fitness or exercise programs; services to enhance athletic training or performance; services or treatment received at intermediate care facilities; submaximal stress testing except for members with cardiovascular disease. Separate 20 visit(s) limit per therapy type per year for physical and occupational therapy. These therapy benefits are only for treatment of those conditions that, in the judgment of the attending health care provider, are expected to yield significant patient improvement, as determined by us. Therapists must be licensed and must not live in the patient's home or be a family member. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Rehabilitative Speech Therapy
Limit: 20.0 Visit(s) per Year Exclusions: Vocational rehabilitation, including work hardening programs; hearing therapy for communication delay, therapy for perceptual disorders, intellectual disability and related conditions, and other long-term special therapy, except as specifically listed under habilitative services or autism spectrum disorder section; therapy services such as recreational or educational therapy, physical fitness or exercise programs; services to enhance athletic training or performance; services or treatment received at intermediate care facilities; submaximal stress testing except for members with cardiovascular disease. 20 visit(s) limit per year for Speech Therapy. These therapy benefits are only for treatment of those conditions that, in the judgment of the attending health care provider, are expected to yield significant patient improvement, as determined by us. Therapists must be licensed and must not live in the patient's home or be a family member. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Routine Dental Services (Adult)
|
NO | ||
Routine Eye Exam (Adult)
|
NO | ||
Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Benefit Period Exclusions: Refractive eye surgery and radial keratotomy; contact lenses (except as a part of cataract surgery or therapeutic contact lenses as defined as covered); refractive exams related to contact lenses; any fitting of contact lenses (except for fitting of therapeutic contact lenses as defined as covered); refraction aids for low vision and instruction in their use. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Routine Foot Care
|
NO | ||
Skilled Nursing Facility
Limit: 30.0 Days per Stay Exclusions: Respite and residential care; any nursing facility services other than skilled nursing services, including intermediate care facilities and community re-entry programs; custodial care; charges for injectable medications administered in a nursing home when we do not cover the nursing home stay; tracheostomy care (if not skilled care); parenteral feeding or tube feeding care. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Specialist Visit
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Specialty Drugs
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Substance Abuse Disorder Inpatient Services
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Substance Abuse Disorder Outpatient Services
Exclusions: Biofeedback; family counseling for non-medical reasons; wilderness and camp programs, boarding school, academy-vocational programs and group homes; halfway houses; hypnotherapy; long-term or maintenance therapy; marriage counseling; phototherapy. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Transplant
Exclusions: Health services for organ and tissue transplants unless specifically covered under the policy. Organ procurement costs for a member who is donating an organ to another person. Health services for transplants involving permanent mechanical or animal organs. Transplant services that are not performed at an approved facility. Services and supplies in connection with covered transplants when prior authorization is not obtained. Any experimental or investigational transplant. Transplants involving non-human or artificial organs. |
YES | 5.00% Coinsurance after deductible |
100.00% |
Treatment for Temporomandibular Joint Disorders
Diagnostic procedures including diagnostic casts, diagnostic study models and bite adjustment and medically necessary surgical or non-surgical treatment for the correction of temporomandibular joint disorders (TMJ), if the following apply: Services are provided under the accepted standards of the profession of the health care provider providing the service, the procedure or device is reasonable and appropriate for the diagnosis or treatment of this condition, the purpose of the procedure or device is to control or eliminate infection, pain, disease or dysfunction. Orthognathic surgery only for the treatment of TMJ (Prior authorization may be required). |
YES | 5.00% Coinsurance after deductible |
100.00% |
Urgent Care Centers or Facilities
|
YES | 5.00% Coinsurance after deductible |
5.00% Coinsurance after deductible |
Weight Loss Programs
|
NO | ||
Well Baby Visits and Care
|
YES | 100.00% | |
X-rays and Diagnostic Imaging
|
YES | 5.00% Coinsurance after deductible |
100.00% |
Plan Attribute | Value |
---|---|
AV Calculator Output Number | 0.9462942315516929 |
Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
Business Year | 2024 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | 94% AV Level Silver Plan |
Dental Only Plan | No |
Design Type | Not Applicable |
Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, Pregnancy |
EHB Percent of Total Premium | 1.0 |
First Tier Utilization | 100% |
Formulary ID | WIF010 |
Formulary URL | URL |
HIOS Product ID | 38345WI008 |
Import Date | 2023-11-18 14:46:48 |
Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
Inpatient Copayment Maximum Days | 0 |
HSA Eligible | No |
New/Existing Plan | Existing |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | No |
Issuer ID | 38345 |
Issuer Marketplace Marketing Name | Dean Health Plan |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | Yes |
Medical Drug Maximum Out of Pocket Integrated | Yes |
Metal Level | Silver |
Multiple In Network Tiers | No |
National Network | No |
Network ID | WIN002 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Emergency Only |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Emergency Only |
Plan Brochure | URL |
Plan Effective Date | 2024-01-01 |
Plan Expiration Date | 2024-12-31 |
Plan ID (Standard Component ID with Variant) | 38345WI0080032-06 |
Plan Level Exclusions | See policy or plan document for additional excluded services. |
Plan Marketing Name | Dean Focus Network Silver HSA-E HDHP 3550X |
Plan Type | EPO |
Plan Variant Marketing Name | Dean Focus Network Silver 250X |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $600 |
SBC Scenario, Having a Baby, Copayment | $0 |
SBC Scenario, Having a Baby, Deductible | $250 |
SBC Scenario, Having a Baby, Limit | $60 |
SBC Scenario, Having Diabetes, Coinsurance | $300 |
SBC Scenario, Having Diabetes, Copayment | $0 |
SBC Scenario, Having Diabetes, Deductible | $250 |
SBC Scenario, Having Diabetes, Limit | $20 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $100 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $250 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | WIS003 |
Source Name | HIOS |
Plan ID | 38345WI0080032 |
State Code | WI |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person 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 Group | per group not applicable |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person 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 | 5.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $500 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $250 per person |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $250 |
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $3000 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $1500 per person |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $1,500 |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
Unique Plan Design | No |
URL for Enrollment Payment | URL |
URL for Summary of Benefits & Coverage | URL |
Wellness Program Offered | No |
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, 27 Aug 2024 05:58 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