Personal Choice PPO Gold Preferred - 31609PA0070012 Health Insurance Plan
QCC Insurance Company, Inc. health insurance plan with the Plan ID 31609PA0070012. The plan is called Personal Choice PPO Gold Preferred.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.99% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.01% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 31609PA0070012 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | QCC Insurance Company, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 31609PA0070012-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 31609PA0070012-01 |
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| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Personal Choice PPO Gold Preferred Health Insurance Plan Variant 31609PA0070012-01 Attributes
| Plan Attribute | Value |
|---|---|
| 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 | 50.00% |
| 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 | $0 per person | $0 per group |
| Drug EHB Deductible, Out of Network, Individual | $0 |
| 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 | 100% |
| First Tier Utilization | 100% |
| Formulary ID | PAF003 |
| HIOS Product ID | 31609PA007 |
| Import Date | 2/12/2024 |
| Inpatient Copayment Maximum Days | 5 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 81.99% |
| Issuer ID | 31609 |
| 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 | $6000 per person | $12000 per group |
| Medical EHB Deductible, Out of Network, Individual | $6,000 |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | PAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Coverage is provided for benefits received while outside of the U.S. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage is provided for benefits received anywhere in the U.S. |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 31609PA0070012-01 |
| Plan Level Exclusions | Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs |
| Plan Marketing Name | Personal Choice PPO Gold Preferred |
| Plan Type | PPO |
| Plan Variant Marketing Name | Personal Choice PPO Gold Preferred |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $800 |
| SBC Scenario, Having a Baby, Copayment | $1,200 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $20 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $2,400 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $70 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $700 |
| 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 | 31609PA0070012 |
| 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 | $8000 per person | $16000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $12000 per person | $24000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $12,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Personal Choice PPO Gold Preferred Health Insurance Plan, 31609PA0070012
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Personal Choice PPO Gold Preferred, 31609PA0070012 Health Insurance Plan, 31609PA0070012
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Does Personal Choice PPO Gold Preferred Health Insurance Plan, 31609PA0070012 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (31609PA0070012) Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs?
Does (31609PA0070012) Health Insurance Plan, Variant (31609PA0070012-01) have Out Of Country Coverage?
Does (31609PA0070012) Health Insurance Plan, Variant (31609PA0070012-01) have Out of Service Area Coverage?
Does (31609PA0070012) Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs?
Does Personal Choice PPO Gold Preferred Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs for Asthma?
Does Personal Choice PPO Gold Preferred Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs for Heart disease?
Does Personal Choice PPO Gold Preferred Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs for Depression?
Does Personal Choice PPO Gold Preferred Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs for Diabetes?
Does Personal Choice PPO Gold Preferred Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Personal Choice PPO Gold Preferred Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs for Low back pain?
Does Personal Choice PPO Gold Preferred Health Insurance Plan, Variant (31609PA0070012-01) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 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