Blue Cross of Idaho Health Service, Inc. health insurance plan with the Plan ID 61589ID2360049. The plan is called KCN North Catastrophic 9100.
Health Insurance Plan ID | 61589ID2360049 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Idaho | ||||||||||||||||||
Health Insurance Issuer | Blue Cross of Idaho Health Service, Inc. | ||||||||||||||||||
Health Insurance Plan Variant | 61589ID2360049-01 | ||||||||||||||||||
Provider Network(s) | ['IDN010'] | ||||||||||||||||||
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 | |||||||||||||||||||
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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Begin Primary Care Deductible Coinsurance After Number Of Copays | 3 |
Business Year | 2023 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard Catastrophic On Exchange Plan |
Dental Only Plan | No |
Design Type | Not Applicable |
Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, Pregnancy, Weight Loss Programs, High Blood Pressure & High Cholesterol |
First Tier Utilization | 100% |
Formulary ID | IDF003 |
HIOS Product ID | 61589ID236 |
Import Date | 1/23/2023 |
HSA Eligible | No |
IsItANewPlan | Existing |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | Yes |
Issuer ID | 61589 |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | Yes |
Medical Drug Maximum Out of Pocket Integrated | Yes |
Metal Level | Catastrophic |
Multiple In Network Tiers | No |
National Network | Yes |
Network ID | IDN010 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply. |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services. Except as provided by the federal No Surprises Act. |
Plan Effective Date | 1/1/2023 |
Plan Expiration Date | 12/31/2023 |
Plan ID (Standard Component ID with Variant) | 61589ID2360049-01 |
Plan Marketing Name | KCN North Catastrophic 9100 |
Plan Type | POS |
Plan Variant Marketing Name | KCN North Catastrophic 9100 |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $0 |
SBC Scenario, Having a Baby, Copayment | $0 |
SBC Scenario, Having a Baby, Deductible | $9,100 |
SBC Scenario, Having a Baby, Limit | $60 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $90 |
SBC Scenario, Having Diabetes, Deductible | $4,250 |
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 | IDS013 |
Source Name | SERFF |
Specialist Requiring a Referral | Allergy/Immunology, Audiologist, Cardiology, Cardiothoracic Surgery, Colorectal Surgery, Dermatology, Endocrinology, ENT/Otolaryngology, Gastroenterology, General Surgery, Hand Surgery, Hepatologist, Infectious Disease, Neonatologist, Nephrology, Neurology, Neurosurgery, Oncology/Hematology, Oral Surgery, Ophthalmology, Orthopedics, Pain Management, Perinatologist, Plastic Surgery, Podiatry, Proctology, Psychiatry, Pulmonology, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery |
Plan ID | 61589ID2360049 |
State Code | ID |
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 | 0.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $9100 per person | $18200 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,100 |
TEHBDedOutofNetFamily | $18200 per person | $36400 per group |
Combined Medical and Drug EHB Deductible, Out of Network, Individual | $18,200 |
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 | $91000 per person | $182000 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $91,000 |
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