PQA Southeast Catastrophic Connect 9450 - 61589ID2360001 Health Insurance Plan
Blue Cross of Idaho Health Service, Inc. health insurance plan with the Plan ID 61589ID2360001. The plan is called PQA Southeast Catastrophic Connect 9450.
| Health Insurance Plan ID | 61589ID2360001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross of Idaho Health Service, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 61589ID2360001-01 | ||||||||||||||||||
| Provider Network(s) | ['IDN006'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
PQA Southeast Catastrophic Connect 9450 Health Insurance Plan Variant 61589ID2360001-01 Attributes
| Plan Attribute | Value |
|---|---|
| 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 Catastrophic On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | IDF003 |
| HIOS Product ID | 61589ID236 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 61589 |
| 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 | Yes |
| Network ID | IDN006 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services. Except as provided by the federal No Surprises Act. |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 61589ID2360001-01 |
| Plan Marketing Name | PQA Southeast Catastrophic Connect 9450 |
| Plan Type | POS |
| Plan Variant Marketing Name | PQA Southeast Catastrophic Connect 9450 |
| QHP/Non QHP | Both |
| 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 | $90 |
| 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 | IDS007 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Allergy/Immunology, Audiologist, Bariatrics, Cardiology, Cardiovascular Surgery, Colon and Rectal Surgery, Dermatology, Endocrinology, Gastroenterology, General Surgery, Genetics Specialist, Hand Surgery, Hematology, Infectious Disease, Neonatology, Nephrology, Neurological Surgery, Neurology, Oncology, Ophthalmology, Oral Surgery, Orthopedic, Otolaryngology/ENT, Physical Medicine and Rehabilitation, Plastic Surgery, Podiatrist, Proctology, Psychiatry, Psychologist, Pulmonary Disease, Radiology, Rheumatology, Thoracic Surgery, Urology, Vascular Surgery |
| Plan ID | 61589ID2360001 |
| State Code | ID |
| 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 | $18900 per person | $37800 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $18,900 |
| 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 | $94500 per person | $189000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $94,500 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, 61589ID2360001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about PQA Southeast Catastrophic Connect 9450, 61589ID2360001 Health Insurance Plan, 61589ID2360001
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Does PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, 61589ID2360001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (61589ID2360001) Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma
Does (61589ID2360001) Health Insurance Plan, Variant (61589ID2360001-01) have Out Of Country Coverage?
Yes. Details: The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply.
Does (61589ID2360001) Health Insurance Plan, Variant (61589ID2360001-01) have Out of Service Area Coverage?
Yes. Details: In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services. Except as provided by the federal No Surprises Act.
Does (61589ID2360001) Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Diabetes, Heart Disease, Asthma
Does PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs for Asthma?
Yes, the PQA Southeast Catastrophic Connect 9450 Health Insurance Plan Variant
61589ID2360001-01 offers Disease
Management Program for Asthma.
Does PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs for Heart disease?
Yes, the PQA Southeast Catastrophic Connect 9450 Health Insurance Plan Variant
61589ID2360001-01 offers Disease
Management Program for Heart disease.
Does PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs for Diabetes?
Yes, the PQA Southeast Catastrophic Connect 9450 Health Insurance Plan Variant
61589ID2360001-01 offers Disease
Management Program for Diabetes.
Does PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the PQA Southeast Catastrophic Connect 9450 Health Insurance Plan Variant
61589ID2360001-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs for Pregnancy?
Yes, the PQA Southeast Catastrophic Connect 9450 Health Insurance Plan Variant
61589ID2360001-01 offers Disease
Management Program for Pregnancy.
Does PQA Southeast Catastrophic Connect 9450 Health Insurance Plan, Variant (61589ID2360001-01) offer Disease Management Programs for Weight loss programs?
Yes, the PQA Southeast Catastrophic Connect 9450 Health Insurance Plan Variant
61589ID2360001-01 offers Disease
Management Program for Weight loss programs.
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