HSA Qualified 3500 Silver - 56707OR1150021 Health Insurance Plan
Providence Health Plan health insurance plan with the Plan ID 56707OR1150021. The plan is called HSA Qualified 3500 Silver.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.16% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.84% 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 70.24% (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 29.76% 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 | 56707OR1150021 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | Providence Health Plan | ||||||||||||||||||
| Health Insurance Plan Variant | 56707OR1150021-01 | ||||||||||||||||||
| Provider Network(s) | ['ORN001'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
HSA Qualified 3500 Silver Health Insurance Plan Variant 56707OR1150021-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.702440931 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| First Tier Utilization | 100% |
| Formulary ID | ORF009 |
| HIOS Product ID | 56707OR115 |
| HSA/HRA Employer Contribution | No |
| Import Date | 2/12/2024 |
| HSA Eligible | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 70.16% |
| Issuer ID | 56707 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | ORN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Out of Network Benefits Apply |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | National Network and Out of Network Benefits Apply |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 56707OR1150021-01 |
| Plan Marketing Name | HSA Qualified 3500 Silver |
| Plan Type | PPO |
| Plan Variant Marketing Name | HSA Qualified 3500 Silver |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,700 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $3,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $600 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $3,500 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| 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 | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ORS001 |
| Source Name | SERFF |
| Plan ID | 56707OR1150021 |
| State Code | OR |
| 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 | $3500 per person | $7000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,500 |
| TEHBDedOutofNetFamily | $7000 per person | $14000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $7,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $7000 per person | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $14000 per person | $28000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $14,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of HSA Qualified 3500 Silver Health Insurance Plan, 56707OR1150021
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about HSA Qualified 3500 Silver, 56707OR1150021 Health Insurance Plan, 56707OR1150021
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Does HSA Qualified 3500 Silver Health Insurance Plan, 56707OR1150021 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (56707OR1150021) Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs?
Does (56707OR1150021) Health Insurance Plan, Variant (56707OR1150021-01) have Out Of Country Coverage?
Does (56707OR1150021) Health Insurance Plan, Variant (56707OR1150021-01) have Out of Service Area Coverage?
Does (56707OR1150021) Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs?
Does HSA Qualified 3500 Silver Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs for Asthma?
Does HSA Qualified 3500 Silver Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs for Heart disease?
Does HSA Qualified 3500 Silver Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs for Depression?
Does HSA Qualified 3500 Silver Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs for Diabetes?
Does HSA Qualified 3500 Silver Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does HSA Qualified 3500 Silver Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs for Low back pain?
Does HSA Qualified 3500 Silver Health Insurance Plan, Variant (56707OR1150021-01) offer Disease Management Programs for Pregnancy?
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