Health Options Clear Choice Gold $1500 PPO National - 33653ME0060005 Health Insurance Plan
Maine Community Health Options health insurance plan with the Plan ID 33653ME0060005. The plan is called Health Options Clear Choice Gold $1500 PPO National.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 80.26% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 19.74% 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 82.43% (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 17.57% 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 | 33653ME0060005 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Maine | ||||||||||||||||||
| Health Insurance Issuer | Maine Community Health Options | ||||||||||||||||||
| Health Insurance Plan Variant | 33653ME0060005-01 | ||||||||||||||||||
| Provider Network(s) | ['MEN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 33653ME0060005-01 |
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| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan Variant 33653ME0060005-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.824286819 |
| 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 Gold On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 99% |
| First Tier Utilization | 100% |
| Formulary ID | MEF006 |
| HIOS Product ID | 33653ME006 |
| 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 | 80.26% |
| Issuer ID | 33653 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | MEN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | The Plan does not provide Benefits for Services received outside of the United States except for Emergency Services which will be paid in accordance with the Member Benefit Agreement at the Maximum Allowable Amount. If you need additional coverage outside the United States, you should purchase travel medical insurance |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency services coverage available within the United States. Non-emergency service coverage is available outside the Service Area on an Out-of-Network basis. |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 33653ME0060005-01 |
| Plan Marketing Name | Health Options Clear Choice Gold $1500 PPO National |
| Plan Type | PPO |
| Plan Variant Marketing Name | Health Options Clear Choice Gold $1500 PPO National |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $3,276 |
| SBC Scenario, Having a Baby, Copayment | $26 |
| SBC Scenario, Having a Baby, Deductible | $1,500 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $544 |
| SBC Scenario, Having Diabetes, Deductible | $159 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $177 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $275 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MES001 |
| Source Name | SERFF |
| Plan ID | 33653ME0060005 |
| State Code | ME |
| 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 | 30.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $1500 per person | $3000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,500 |
| TEHBDedOutofNetFamily | $9000 per person | $18000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $9,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $5000 per person | $10000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $5,000 |
| 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 Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, 33653ME0060005
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Health Options Clear Choice Gold $1500 PPO National, 33653ME0060005 Health Insurance Plan, 33653ME0060005
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Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, 33653ME0060005 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (33653ME0060005) Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs?
Does (33653ME0060005) Health Insurance Plan, Variant (33653ME0060005-01) have Out Of Country Coverage?
Does (33653ME0060005) Health Insurance Plan, Variant (33653ME0060005-01) have Out of Service Area Coverage?
Does (33653ME0060005) Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for Asthma?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for Heart disease?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for Depression?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for Diabetes?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for Low back pain?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for Pregnancy?
Does Health Options Clear Choice Gold $1500 PPO National Health Insurance Plan, Variant (33653ME0060005-01) offer Disease Management Programs for Weight loss programs?
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