IHC Bronze EPO HSA Local Value 50%/50% - 91762NJ0070105 Health Insurance Plan

AmeriHealth Insurance Company of New Jersey health insurance plan with the Plan ID 91762NJ0070105. The plan is called IHC Bronze EPO HSA Local Value 50%/50% .

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 63.38% (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 36.62% 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 91762NJ0070105
Health Insurance Plan Year 2024
State New Jersey
Health Insurance Issuer AmeriHealth Insurance Company of New Jersey
Health Insurance Plan Variant 91762NJ0070105-03
Provider Network(s) ['NJN002']
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 Jersey 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 - 91762NJ0070105-01

Open to Indians below 300% FPL - 91762NJ0070105-02

Open to Indians above 300% FPL - 91762NJ0070105-03

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

IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan Variant 91762NJ0070105-03 Attributes

Plan Attribute Value
AV Calculator Output Number 0.633811741
Business Year 2024
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
Disease Management Programs Offered Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma
EHB Percent of Total Premium 99%
First Tier Utilization 100%
Formulary ID NJF018
HIOS Product ID 91762NJ007
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy Yes
Is a Referral Required for Specialist? No
Issuer ID 91762
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 No
Network ID NJN002
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Services are available in Hunterdon County. Emergency Care is covered outside of the service area.
Plan Effective Date 1/1/2024
Plan ID (Standard Component ID with Variant) 91762NJ0070105-03
Plan Marketing Name IHC Bronze EPO HSA Local Value 50%/50%
Plan Type EPO
Plan Variant Marketing Name IHC Bronze EPO Local Value 50%/50% Limited
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $900
SBC Scenario, Having a Baby, Copayment $30
SBC Scenario, Having a Baby, Deductible $2,500
SBC Scenario, Having a Baby, Limit $200
SBC Scenario, Having Diabetes, Coinsurance $40
SBC Scenario, Having Diabetes, Copayment $1,300
SBC Scenario, Having Diabetes, Deductible $2,500
SBC Scenario, Having Diabetes, Limit $60
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 $1,900
SBC Scenario, Treatment of a Simple Fracture, Limit $30
Service Area ID NJS002
Source Name SERFF
Plan ID 91762NJ0070105
State Code NJ
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 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $6000 per person | $12000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,000
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 $8000 per person | $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,000
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 No
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of IHC Bronze EPO HSA Local Value 50%/50% Health Insurance Plan, 91762NJ0070105

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

Frequently Asked Questions(FAQ) about IHC Bronze EPO HSA Local Value 50%/50% , 91762NJ0070105 Health Insurance Plan, 91762NJ0070105

  • Does IHC Bronze EPO HSA Local Value 50%/50% Health Insurance Plan, 91762NJ0070105 support Mail Ordering?

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

    • Does (91762NJ0070105) Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma

    Does (91762NJ0070105) Health Insurance Plan, Variant (91762NJ0070105-03) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (91762NJ0070105) Health Insurance Plan, Variant (91762NJ0070105-03) have Out of Service Area Coverage?

    Yes. Details: Services are available in Hunterdon County. Emergency Care is covered outside of the service area.

    Does (91762NJ0070105) Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma

    Does IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs for Asthma?

    Yes, the IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan Variant 91762NJ0070105-03 offers Disease Management Program for Asthma.

    Does IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs for Heart disease?

    Yes, the IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan Variant 91762NJ0070105-03 offers Disease Management Program for Heart disease.

    Does IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs for Diabetes?

    Yes, the IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan Variant 91762NJ0070105-03 offers Disease Management Program for Diabetes.

    Does IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan Variant 91762NJ0070105-03 offers Disease Management Program for High blood pressure & high cholesterol.

    Does IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs for Pregnancy?

    Yes, the IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan Variant 91762NJ0070105-03 offers Disease Management Program for Pregnancy.

    Does IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan, Variant (91762NJ0070105-03) offer Disease Management Programs for Weight loss programs?

    Yes, the IHC Bronze EPO Local Value 50%/50% Limited Health Insurance Plan Variant 91762NJ0070105-03 offers Disease Management Program 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