Regence BlueShield of Idaho health insurance plan with the Plan ID 44648ID1350003. The plan is called IAFN Bronze Essential 8000 With 4 Copay No Deductible Office Visits POS.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.16% (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 36.84% 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 | 44648ID1350003 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Idaho | ||||||||||||||||||
Health Insurance Issuer | Regence BlueShield of Idaho | ||||||||||||||||||
Health Insurance Plan Variant | 44648ID1350003-03 | ||||||||||||||||||
Provider Network(s) | ['IDN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 20 Aug 2024 06:14 GMT). |
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Available Variants of the Health Plan | Standard On Exchange Plan - 44648ID1350003-01 |
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Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 20 Aug 2024 06:14 GMT |
Plan Attribute | Value |
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AV Calculator Output Number | 0.6315837 |
Begin Primary Care Deductible Coinsurance After Number Of Copays | 4 |
Business Year | 2023 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Limited Cost Sharing Plan Variation |
Dental Only Plan | No |
Design Type | Not Applicable |
EHB Percent of Total Premium | 100% |
First Tier Utilization | 100% |
Formulary ID | IDF007 |
HIOS Product ID | 44648ID135 |
Import Date | 1/23/2023 |
HSA Eligible | No |
IsItANewPlan | Existing |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | Yes |
Issuer ID | 44648 |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | Yes |
Medical Drug Maximum Out of Pocket Integrated | Yes |
Metal Level | Expanded Bronze |
Multiple In Network Tiers | No |
National Network | Yes |
Network ID | IDN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Members traveling outside the United States receive coverage for the same benefits as inside the United States. Members who do not seek inpatient care at a BlueCross BlueShield Global Hospital may have to pay a provider upfront for care and submit an international claim form to be reimbursed. |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Out of Area benefits are covered on Blue Card which provides access to the largest network of doctors in the United States |
Plan Effective Date | 1/1/2023 |
Plan ID (Standard Component ID with Variant) | 44648ID1350003-03 |
Plan Marketing Name | IAFN Bronze Essential 8000 With 4 Copay No Deductible Office Visits POS |
Plan Type | POS |
Plan Variant Marketing Name | IAFN Bronze Essential 8000 With 4 Copay No Deductible Office Visits POS |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $422 |
SBC Scenario, Having a Baby, Copayment | $11 |
SBC Scenario, Having a Baby, Deductible | $8,000 |
SBC Scenario, Having a Baby, Limit | $61 |
SBC Scenario, Having Diabetes, Coinsurance | $625 |
SBC Scenario, Having Diabetes, Copayment | $499 |
SBC Scenario, Having Diabetes, Deductible | $877 |
SBC Scenario, Having Diabetes, Limit | $178 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $185 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,454 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | IDS001 |
Source Name | SERFF |
Specialist Requiring a Referral | A provider focusing on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions. |
Plan ID | 44648ID1350003 |
State Code | ID |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | $90600 per person | $181200 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $90,600 |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | $24300 per person | $48600 per group |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $24,300 |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 10.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $8000 per person | $16000 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,000 |
TEHBDedOutofNetFamily | $16300 per person | $32600 per group |
Combined Medical and Drug EHB Deductible, Out of Network, Individual | $16,300 |
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 | $81500 per person | $163000 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $81,500 |
Unique Plan Design | No |
Version Number | 1 |
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, 20 Aug 2024 06:14 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