Geisinger Marketplace All-Access PPO 30/60/5500 - 75729PA0012668 Health Insurance Plan
Geisinger Quality Options health insurance plan with the Plan ID 75729PA0012668. The plan is called Geisinger Marketplace All-Access PPO 30/60/5500.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.09% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.91% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 69.84% (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 30.16% 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 | 75729PA0012668 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | Geisinger Quality Options | ||||||||||||||||||
| Health Insurance Plan Variant | 75729PA0012668-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN001'] | ||||||||||||||||||
| 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 - 75729PA0012668-01 Open to Indians below 300% FPL - 75729PA0012668-02 Open to Indians above 300% FPL - 75729PA0012668-03 73% AV Silver Plan - 75729PA0012668-04 |
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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 |
Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan Variant 75729PA0012668-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.698446251 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver 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 | $500 per person | $1000 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $500 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | PAF005 |
| HIOS Product ID | 75729PA001 |
| 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 | 70.09% |
| Issuer ID | 75729 |
| 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 | $5500 per person | $11000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $5,500 |
| Medical EHB Deductible, Out of Network, Family | $10000 per person | $20000 per group |
| Medical EHB Deductible, Out of Network, Individual | $10,000 |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | PAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergent and urgent care covered. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergent and urgent care covered. Other services covered with precertification. |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 75729PA0012668-01 |
| Plan Level Exclusions | Acupuncture, Bariatric Surgery, Cosmetic Surgery, Hearing Aids, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Adult Dental Care, Adult Orthodontia |
| Plan Marketing Name | Geisinger Marketplace All-Access PPO 30/60/5500 |
| Plan Type | PPO |
| Plan Variant Marketing Name | Geisinger Marketplace All-Access PPO 30/60/5500 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,000 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $5,500 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $300 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,300 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | PAS003 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $9,100 |
| Plan ID | 75729PA0012668 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $9100 per person | $18200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $15000 per person | $30000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $15,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, 75729PA0012668
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Geisinger Marketplace All-Access PPO 30/60/5500, 75729PA0012668 Health Insurance Plan, 75729PA0012668
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Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, 75729PA0012668 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (75729PA0012668) Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs?
Does (75729PA0012668) Health Insurance Plan, Variant (75729PA0012668-01) have Out Of Country Coverage?
Does (75729PA0012668) Health Insurance Plan, Variant (75729PA0012668-01) have Out of Service Area Coverage?
Does (75729PA0012668) Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs?
Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs for Asthma?
Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs for Heart disease?
Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs for Depression?
Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs for Diabetes?
Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs for Pregnancy?
Does Geisinger Marketplace All-Access PPO 30/60/5500 Health Insurance Plan, Variant (75729PA0012668-01) offer Disease Management Programs for Weight loss programs?
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