Jefferson Health Plans + Total + Bronze + HMO - 93909PA0010002 Health Insurance Plan
Jefferson Health Plans health insurance plan with the Plan ID 93909PA0010002. The plan is called Jefferson Health Plans + Total + Bronze + HMO.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.63% (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 35.37% 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 | 93909PA0010002 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | Jefferson Health Plans | ||||||||||||||||||
| Health Insurance Plan Variant | 93909PA0010002-01 | ||||||||||||||||||
| 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 - 93909PA0010002-01 |
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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 |
Jefferson Health Plans + Total + Bronze + HMO + On Exchange Health Insurance Plan Variant 93909PA0010002-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.646251432 |
| 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 Bronze On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 70% |
| Formulary ID | PAF002 |
| HIOS Product ID | 93909PA001 |
| Import Date | 2/12/2024 |
| Inpatient Copayment Maximum Days | 5 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 93909 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | PAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Covered Emergency Services only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Covered Emergency Services only |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 93909PA0010002-01 |
| Plan Marketing Name | Jefferson Health Plans + Total + Bronze + HMO |
| Plan Type | HMO |
| Plan Variant Marketing Name | Jefferson Health Plans + Total + Bronze + HMO + On Exchange |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,600 |
| SBC Scenario, Having a Baby, Deductible | $7,900 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $2,800 |
| SBC Scenario, Having Diabetes, Deductible | $800 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $800 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,000 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 30% |
| Service Area ID | PAS001 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $1,000 |
| Plan ID | 93909PA0010002 |
| 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 |
| 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 | $7900 per person | $15800 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,900 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family | $9450 per person | $18900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $9,450 |
| 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 | $9450 per person | $18900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,450 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family | $9450 per person | $18900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $9,450 |
| 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 | No |
Copay & Coinsurance of Jefferson Health Plans + Total + Bronze + HMO Health Insurance Plan, 93909PA0010002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Jefferson Health Plans + Total + Bronze + HMO, 93909PA0010002 Health Insurance Plan, 93909PA0010002
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Does Jefferson Health Plans + Total + Bronze + HMO Health Insurance Plan, 93909PA0010002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (93909PA0010002) Health Insurance Plan, Variant (93909PA0010002-01) have Out Of Country Coverage?
Does (93909PA0010002) Health Insurance Plan, Variant (93909PA0010002-01) have Out of Service Area Coverage?
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