my Blue Access PPO Premier Gold 0 - 33709PA1520001 Health Insurance Plan
Highmark Inc. health insurance plan with the Plan ID 33709PA1520001. The plan is called my Blue Access PPO Premier Gold 0 .
Based on the data of Health Plan Issuer, this plan has an actuarial value of 82.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.00% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 83.21% (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 16.79% 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 | 33709PA1520001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | Highmark Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 33709PA1520001-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN003'] | ||||||||||||||||||
| 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 - 33709PA1520001-01 |
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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 |
my Blue Access PPO Premier Gold 0 Health Insurance Plan Variant 33709PA1520001-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.832083083 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 99% |
| First Tier Utilization | 100% |
| Formulary ID | PAF005 |
| HIOS Product ID | 33709PA152 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 82.00% |
| Issuer ID | 33709 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family | $1500 per person | $3000 per group |
| Medical EHB Deductible, Out of Network, Individual | $1,500 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | PAN003 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | If a member receives non-emergency medically necessary and appropriate care from an out-of-area Blue Card provider, benefits will be paid in accordance with the contract. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level and the member will be financially responsible for the difference between the plan's payment and the full amount of the out-of-area provider's charge |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 33709PA1520001-01 |
| Plan Marketing Name | my Blue Access PPO Premier Gold 0 |
| Plan Type | PPO |
| Plan Variant Marketing Name | my Blue Access PPO Premier Gold 0 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,100 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $200 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | PAS001 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $1,000 |
| Plan ID | 33709PA1520001 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $6550 per person | $13100 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $6,550 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $13100 per person | $26200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $13,100 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of my Blue Access PPO Premier Gold 0 Health Insurance Plan, 33709PA1520001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about my Blue Access PPO Premier Gold 0 , 33709PA1520001 Health Insurance Plan, 33709PA1520001
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Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, 33709PA1520001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (33709PA1520001) Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs?
Does (33709PA1520001) Health Insurance Plan, Variant (33709PA1520001-01) have Out Of Country Coverage?
Does (33709PA1520001) Health Insurance Plan, Variant (33709PA1520001-01) have Out of Service Area Coverage?
Does (33709PA1520001) Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for Asthma?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for Heart disease?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for Depression?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for Diabetes?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for Low back pain?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for Pregnancy?
Does my Blue Access PPO Premier Gold 0 Health Insurance Plan, Variant (33709PA1520001-01) offer Disease Management Programs for Weight loss programs?
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