EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP - 88582NY4280001 Health Insurance Plan

Health Insurance Plan of Greater New York health insurance plan with the Plan ID 88582NY4280001. The plan is called EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 61.87% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 38.13% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 88582NY4280001
Health Insurance Plan Year 2024
State New York
Health Insurance Issuer Health Insurance Plan of Greater New York
Health Insurance Plan Variant 88582NY4280001-01
Provider Network(s) ['NYN002']
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 New York 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 - 88582NY4280001-01

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

EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP Health Insurance Plan Variant 88582NY4280001-01 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits 1
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
First Tier Utilization 100%
Formulary ID NYF008
HIOS Product ID 88582NY428
HSA/HRA Employer Contribution No
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy Yes
Is a Referral Required for Specialist? No
Issuer Actuarial Value 61.87%
Issuer ID 88582
Market Coverage SHOP (Small Group)
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID NYN002
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 Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 88582NY4280001-01
Plan Marketing Name EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP
Plan Type HMO
Plan Variant Marketing Name EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $4,915
SBC Scenario, Having a Baby, Copayment $1,190
SBC Scenario, Having a Baby, Deductible $7,100
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $2,412
SBC Scenario, Having Diabetes, Copayment $2,255
SBC Scenario, Having Diabetes, Deductible $7,100
SBC Scenario, Having Diabetes, Limit $55
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $816
SBC Scenario, Treatment of a Simple Fracture, Copayment $210
SBC Scenario, Treatment of a Simple Fracture, Deductible $7,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID NYS002
Source Name SERFF
Plan ID 88582NY4280001
State Code NY
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 100.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $7100 per person | $14200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $7,100
TEHBDedOutofNetFamily per person not applicable | per group 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 $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 per person not applicable | per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design Yes
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP Health Insurance Plan, 88582NY4280001

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

Frequently Asked Questions(FAQ) about EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP, 88582NY4280001 Health Insurance Plan, 88582NY4280001

  • Does EmblemHealth Bronze Premier, Bronze, INN, Select Care Network non-gated, Dep29, 1 Free PCP Visit, Free Telemedicine, Pediatric Dental, DP Health Insurance Plan, 88582NY4280001 support Mail Ordering?

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

  • Does (88582NY4280001) Health Insurance Plan, Variant (88582NY4280001-01) have Out Of Country Coverage?

    Yes. Details: Emergency Only

    Does (88582NY4280001) Health Insurance Plan, Variant (88582NY4280001-01) have Out of Service Area Coverage?

    Yes. Details: Emergency Only

 

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