MHP Bronze Saver (Expanded) - 74917MI0020013 Health Insurance Plan

McLaren Health Plan Community health insurance plan with the Plan ID 74917MI0020013. The plan is called MHP Bronze Saver (Expanded).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 61.36% (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 38.64% 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

74917MI0020013

Health Insurance Plan Year

2025

State

Michigan

Health Insurance Issuer

McLaren Health Plan Community

Plan Formulary Description URL

Formulary URL

Health Insurance Plan Variant

74917MI0020013-03

Provider Network(s)

REWARDS OUT-OF-NETWORK IN-NETWORK

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	Michigan	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 Off Exchange Plan - 74917MI0020013-00

Standard On Exchange Plan - 74917MI0020013-01

Open to Indians below 300% FPL - 74917MI0020013-02

Open to Indians above 300% FPL - 74917MI0020013-03

Last Plan Update Date

Sat, 12 Oct 2024 00:00 GMT

Last Import Date

Thu, 21 Nov 2024 00:44 GMT

Benefits of MHP Bronze Saver (Expanded) Health Insurance Plan, 74917MI0020013-03

Benefit	Covered	In Network	Out Of Network
Abortion for Which Public Funding is Prohibited	NO
Accidental Dental	NO
Acupuncture	NO
Allergy Testing	YES	No Charge after deductible	100.00%
Applied Behavior Analysis Based Therapies	YES	No Charge after deductible	100.00%
Autism Spectrum Disorders Only covered in relation to Autism Spectrum Disorder.	YES	No Charge after deductible	100.00%
Bariatric Surgery Limit: 1.0 Procedure(s) per Lifetime	YES	No Charge after deductible	100.00%
Basic Dental Care - Adult	NO
Basic Dental Care - Child	NO
Chemotherapy	YES	No Charge after deductible	100.00%
Chiropractic Care Limit: 30.0 Visit(s) per Year Limit combined with OT and PT.	YES	No Charge after deductible	100.00%
Cosmetic Surgery	NO
Delivery and All Inpatient Services for Maternity Care	YES	No Charge after deductible	100.00%
Dental Check-Up for Children	NO
Diabetes Education	YES	No Charge	100.00%
Dialysis	YES	No Charge after deductible	100.00%
Durable Medical Equipment	YES	No Charge after deductible	100.00%
Emergency Room Services	YES	No Charge after deductible	No Charge after deductible
Emergency Transportation/Ambulance	YES	No Charge after deductible	No Charge after deductible
Eye Glasses for Children Limit: 1.0 Item(s) per Year	YES	No Charge after deductible	100.00%
Gender Affirming Care	YES	No Charge after deductible	100.00%
Generic Drugs	YES	No Charge after deductible	100.00%
Habilitation Services Limit: 30.0 Visit(s) per Year Yearly limits: PT and OT: 30 visits, Speech: 30 visits.	YES	No Charge after deductible	100.00%
Hearing Aids	NO
Home Health Care Services	YES	No Charge after deductible	100.00%
Hospice Services Coverage includes inpatient and outpatient hospice care.	YES	No Charge after deductible	100.00%
Imaging (CT/PET Scans, MRIs)	YES	No Charge after deductible	100.00%
Infertility Treatment Underlying causes only.	YES	No Charge after deductible	100.00%
Infusion Therapy	YES	No Charge after deductible	100.00%
Inpatient Hospital Services (e.g., Hospital Stay)	YES	No Charge after deductible	100.00%
Inpatient Physician and Surgical Services	YES	No Charge after deductible	100.00%
Laboratory Outpatient and Professional Services	YES	No Charge after deductible	100.00%
Long-Term/Custodial Nursing Home Care	NO
Major Dental Care - Adult	NO
Major Dental Care - Child	NO
Mental/Behavioral Health Inpatient Services	YES	No Charge after deductible	100.00%
Mental/Behavioral Health Outpatient Services	YES	No Charge after deductible	100.00%
Non-Preferred Brand Drugs	YES	No Charge after deductible	100.00%
Nutritional Counseling Limit: 6.0 Visit(s) per Year Dietician Services.	YES	No Charge	100.00%
Orthodontia - Adult	NO
Orthodontia - Child	NO
Other Practitioner Office Visit (Nurse, Physician Assistant)	YES	No Charge after deductible	100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	YES	No Charge after deductible	100.00%
Outpatient Rehabilitation Services Limit: 30.0 Visit(s) per Year PT/OT/Chiro - combined visits per contract year; 30 ST per contract year; 30 cardiac/pulmonary visits per contract year.	YES	No Charge after deductible	100.00%
Outpatient Surgery Physician/Surgical Services	YES	No Charge after deductible	100.00%
Preferred Brand Drugs	YES	No Charge after deductible	100.00%
Prenatal and Postnatal Care	YES	No Charge	100.00%
Preventive Care/Screening/Immunization	YES	No Charge	100.00%
Primary Care Visit to Treat an Injury or Illness	YES	No Charge after deductible	100.00%
Private-Duty Nursing	NO
Prosthetic Devices	YES	No Charge after deductible	100.00%
Radiation	YES	No Charge after deductible	100.00%
Reconstructive Surgery	YES	No Charge after deductible	100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy Limit: 30.0 Visit(s) per Year Combined with chiro.	YES	No Charge after deductible	100.00%
Rehabilitative Speech Therapy Limit: 30.0 Visit(s) per Year	YES	No Charge after deductible	100.00%
Routine Dental Services (Adult)	NO
Routine Eye Exam (Adult) Limit: 1.0 Exam(s) per Year	YES	No Charge after deductible	100.00%
Routine Eye Exam for Children Limit: 1.0 Exam(s) per Year	YES	No Charge	100.00%
Routine Foot Care	NO
Skilled Nursing Facility Limit: 45.0 Days per Year	YES	No Charge after deductible	100.00%
Specialist Visit	YES	No Charge after deductible	100.00%
Specialty Drugs	YES	No Charge after deductible	100.00%
Substance Abuse Disorder Inpatient Services	YES	No Charge after deductible	100.00%
Substance Abuse Disorder Outpatient Services	YES	No Charge after deductible	100.00%
Transplant	YES	No Charge after deductible	100.00%
Treatment for Temporomandibular Joint Disorders Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental X-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.	YES	No Charge after deductible	100.00%
Urgent Care Centers or Facilities	YES	No Charge after deductible	No Charge after deductible
Weight Loss Programs	YES	No Charge after deductible	100.00%
Well Baby Visits and Care	YES	No Charge	100.00%
X-rays and Diagnostic Imaging	YES	No Charge after deductible	100.00%

MHP Bronze Saver (Expanded) Health Insurance Plan Variant 74917MI0020013-03 Attributes

Plan Attribute	Value
AV Calculator Output Number	0.6136009289871259
Begin Primary Care Cost-Sharing After Number Of Visits	0
Begin Primary Care Deductible Coinsurance After Number Of Copays	0
Business Year	2025
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	0.9994
First Tier Utilization	100%
Formulary ID	MIF014
Formulary URL	URL
HIOS Product ID	74917MI002
Import Date	2024-10-12 20:01:46
Limited Cost Sharing Plan Variation - Estimated Advanced Payment	$0.00
Inpatient Copayment Maximum Days	0
HSA Eligible	No
New/Existing Plan	Existing
Notice Required for Pregnancy	No
Is a Referral Required for Specialist?	No
Issuer ID	74917
Issuer Marketplace Marketing Name	McLaren Health Plan Community
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	MIN001
Out of Country Coverage	Yes
Out of Country Coverage Description	Emergency Only
Out of Service Area Coverage	Yes
Out of Service Area Coverage Description	Emergency Only
Plan Effective Date	2025-01-01
Plan ID (Standard Component ID with Variant)	74917MI0020013-03
Plan Level Exclusions	No
Plan Marketing Name	MHP Bronze Saver (Expanded)
Plan Type	HMO
Plan Variant Marketing Name	MHP Bronze Saver (Expanded)
QHP/Non QHP	Both
SBC Scenario, Having a Baby, Coinsurance	$0
SBC Scenario, Having a Baby, Copayment	$0
SBC Scenario, Having a Baby, Deductible	$8,300
SBC Scenario, Having a Baby, Limit	$60
SBC Scenario, Having Diabetes, Coinsurance	$0
SBC Scenario, Having Diabetes, Copayment	$0
SBC Scenario, Having Diabetes, Deductible	$5,400
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	MIS001
Source Name	SERFF
Plan ID	74917MI0020013
State Code	MI
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group	per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person	per person 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 Group	per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person	per person 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 Per Group	$16600 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person	$8300 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual	$8,300
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group	per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person	per person 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 Per Group	$16600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person	$8300 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual	$8,300
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group	per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person	per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual	Not Applicable
Unique Plan Design	No
URL for Summary of Benefits & Coverage	URL
Wellness Program Offered	No

Copay & Coinsurance of MHP Bronze Saver (Expanded) Health Insurance Plan, 74917MI0020013

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

Frequently Asked Questions(FAQ) about MHP Bronze Saver (Expanded), 74917MI0020013 Health Insurance Plan, 74917MI0020013

Does MHP Bronze Saver (Expanded) Health Insurance Plan, 74917MI0020013 support Mail Ordering?

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

Does (74917MI0020013) Health Insurance Plan, Variant (74917MI0020013-03) have Out Of Country Coverage?

Yes. Details: Emergency Only

Does (74917MI0020013) Health Insurance Plan, Variant (74917MI0020013-03) have Out of Service Area Coverage?