Sharp Health Plan health insurance plan with the Plan ID 92499CA0010008. The plan is called Performance Bronze 60 HMO 6300/60 + Child Dental .
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.40% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.60% 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 64.60% (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 35.40% 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 | 92499CA0010008 | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | California | ||||||||||||||||||
Health Insurance Issuer | Sharp Health Plan | ||||||||||||||||||
Health Insurance Plan Variant | 92499CA0010008-01 | ||||||||||||||||||
Provider Network(s) | ['CAN002'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 GMT). |
|
||||||||||||||||||
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 |
---|---|
AV Calculator Output Number | 0.645987573 |
Begin Primary Care Deductible Coinsurance After Number Of Copays | 3 |
Business Year | 2024 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard Bronze 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 | 40.00% |
Drug EHB Deductible, In Network (Tier 1), Family | $500 per person | $1000 per group |
Drug EHB Deductible, In Network (Tier 1), Individual | $500 |
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 |
First Tier Utilization | 100% |
Formulary ID | CAF001 |
HIOS Product ID | 92499CA001 |
HSA/HRA Employer Contribution | No |
Import Date | 2/12/2024 |
HSA Eligible | No |
IsItANewPlan | Existing |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | Yes |
Issuer Actuarial Value | 64.40% |
Issuer ID | 92499 |
Market Coverage | SHOP (Small Group) |
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 | 40.00% |
Medical EHB Deductible, In Network (Tier 1), Family | $6300 per person | $12600 per group |
Medical EHB Deductible, In Network (Tier 1), Individual | $6,300 |
Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
Medical EHB Deductible, Out of Network, Individual | Not Applicable |
Metal Level | Expanded Bronze |
Multiple In Network Tiers | No |
National Network | No |
Network ID | CAN002 |
Out of Country Coverage | No |
Out of Service Area Coverage | No |
Plan Effective Date | 1/1/2024 |
Plan ID (Standard Component ID with Variant) | 92499CA0010008-01 |
Plan Marketing Name | Performance Bronze 60 HMO 6300/60 + Child Dental |
Plan Type | HMO |
Plan Variant Marketing Name | Performance Bronze 60 HMO 6300/60 + Child Dental |
QHP/Non QHP | On the Exchange |
SBC Scenario, Having a Baby, Coinsurance | $2,000 |
SBC Scenario, Having a Baby, Copayment | $500 |
SBC Scenario, Having a Baby, Deductible | $6,300 |
SBC Scenario, Having a Baby, Limit | $60 |
SBC Scenario, Having Diabetes, Coinsurance | $1,200 |
SBC Scenario, Having Diabetes, Copayment | $400 |
SBC Scenario, Having Diabetes, Deductible | $2,100 |
SBC Scenario, Having Diabetes, Limit | $20 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,000 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | CAS001 |
Source Name | SERFF |
Specialist Requiring a Referral | All Except OB |
Specialty Drug Maximum Coinsurance | $500 |
Plan ID | 92499CA0010008 |
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 |
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 | 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 | Yes |
Version Number | 1 |
Wellness Program Offered | Yes |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
---|
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