Minimum Coverage HMO - 20523CA0110019 Health Insurance Plan
Aetna Health of California, Inc. health insurance plan with the Plan ID 20523CA0110019. The plan is called Minimum Coverage HMO.
| Health Insurance Plan ID | 20523CA0110019 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | California | ||||||||||||||||||
| Health Insurance Issuer | Aetna Health of California, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 20523CA0110019-01 | ||||||||||||||||||
| Provider Network(s) | PREFERRED NON-PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Minimum Coverage HMO Health Insurance Plan Variant 20523CA0110019-01 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 3 |
| Business Year | 2024 |
| 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 | Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 99% |
| First Tier Utilization | 100% |
| Formulary ID | CAF002 |
| HIOS Product ID | 20523CA011 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 20523 |
| 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 | No |
| Network ID | CAN004 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | Except for Emergencies |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 20523CA0110019-01 |
| Plan Marketing Name | Minimum Coverage HMO |
| Plan Type | HMO |
| Plan Variant Marketing Name | Minimum Coverage HMO |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,450 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $4,700 |
| 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 | CAS004 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician. |
| Plan ID | 20523CA0110019 |
| State Code | CA |
| 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 | $9450 per person | $18900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), 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), 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 Minimum Coverage HMO Health Insurance Plan, 20523CA0110019
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Minimum Coverage HMO, 20523CA0110019 Health Insurance Plan, 20523CA0110019
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Does Minimum Coverage HMO Health Insurance Plan, 20523CA0110019 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (20523CA0110019) Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does (20523CA0110019) Health Insurance Plan, Variant (20523CA0110019-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (20523CA0110019) Health Insurance Plan, Variant (20523CA0110019-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan). Details: Except for Emergencies
Does (20523CA0110019) Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does Minimum Coverage HMO Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs for Asthma?
Yes, the Minimum Coverage HMO Health Insurance Plan Variant
20523CA0110019-01 offers Disease
Management Program for Asthma.
Does Minimum Coverage HMO Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs for Heart disease?
Yes, the Minimum Coverage HMO Health Insurance Plan Variant
20523CA0110019-01 offers Disease
Management Program for Heart disease.
Does Minimum Coverage HMO Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs for Depression?
Yes, the Minimum Coverage HMO Health Insurance Plan Variant
20523CA0110019-01 offers Disease
Management Program for Depression.
Does Minimum Coverage HMO Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs for Diabetes?
Yes, the Minimum Coverage HMO Health Insurance Plan Variant
20523CA0110019-01 offers Disease
Management Program for Diabetes.
Does Minimum Coverage HMO Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Minimum Coverage HMO Health Insurance Plan Variant
20523CA0110019-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Minimum Coverage HMO Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs for Low back pain?
Yes, the Minimum Coverage HMO Health Insurance Plan Variant
20523CA0110019-01 offers Disease
Management Program for Low back pain.
Does Minimum Coverage HMO Health Insurance Plan, Variant (20523CA0110019-01) offer Disease Management Programs for Pregnancy?
Yes, the Minimum Coverage HMO Health Insurance Plan Variant
20523CA0110019-01 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 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