County of Santa Clara dba Valley Health Plan health insurance plan with the Plan ID 84014CA0010005. The plan is called Minimum Coverage HMO.
Health Insurance Plan ID | 84014CA0010005 | ||||||||||||||||||
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Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | California | ||||||||||||||||||
Health Insurance Issuer | County of Santa Clara dba Valley Health Plan | ||||||||||||||||||
Health Insurance Plan Variant | 84014CA0010005-01 | ||||||||||||||||||
Provider Network(s) | ['CAN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 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, 17 Dec 2024 06:12 GMT |
Plan Attribute | Value |
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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 |
EHB Percent of Total Premium | 99% |
First Tier Utilization | 100% |
Formulary ID | CAF008 |
HIOS Product ID | 84014CA001 |
Import Date | 2/12/2024 |
HSA Eligible | No |
IsItANewPlan | Existing |
Notice Required for Pregnancy | Yes |
Is a Referral Required for Specialist? | Yes |
Issuer ID | 84014 |
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 | CAN001 |
Out of Country Coverage | No |
Out of Service Area Coverage | No |
Plan Effective Date | 1/1/2024 |
Plan Expiration Date | 12/31/2024 |
Plan ID (Standard Component ID with Variant) | 84014CA0010005-01 |
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 | $8,600 |
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 | $2,400 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | CAS001 |
Source Name | SERFF |
Specialist Requiring a Referral | All |
Plan ID | 84014CA0010005 |
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 |
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, 17 Dec 2024 06:12 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