Hometown Health Plan Inc. health insurance plan with the Plan ID 41094NV0030070. The plan is called Renown Silver HMO $0PCP.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 73.01% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 26.99% 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 73.02% (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 26.98% 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 | 41094NV0030070 | ||||||||||||||||||
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Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Nevada | ||||||||||||||||||
Health Insurance Issuer | Hometown Health Plan Inc. | ||||||||||||||||||
Health Insurance Plan Variant | 41094NV0030070-04 | ||||||||||||||||||
Provider Network(s) | ['NVN001'] | ||||||||||||||||||
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 - 41094NV0030070-01 Open to Indians below 300% FPL - 41094NV0030070-02 Open to Indians above 300% FPL - 41094NV0030070-03 73% AV Silver Plan - 41094NV0030070-04 |
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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 |
Plan Attribute | Value |
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AV Calculator Output Number | 0.730164222 |
Business Year | 2024 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | 73% AV Level Silver Plan |
Dental Only Plan | No |
Design Type | Not Applicable |
EHB Percent of Total Premium | 100% |
First Tier Utilization | 100% |
Formulary ID | NVF004 |
HIOS Product ID | 41094NV003 |
Import Date | 2/12/2024 |
HSA Eligible | No |
IsItANewPlan | New |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | Yes |
Issuer Actuarial Value | 73.01% |
Issuer ID | 41094 |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | Yes |
Medical Drug Maximum Out of Pocket Integrated | Yes |
Metal Level | Silver |
Multiple In Network Tiers | No |
National Network | No |
Network ID | NVN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Emergencies and urgent care only. |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Emergencies and urgent care only. |
Plan Effective Date | 1/1/2024 |
Plan Expiration Date | 12/31/2024 |
Plan ID (Standard Component ID with Variant) | 41094NV0030070-04 |
Plan Level Exclusions | None |
Plan Marketing Name | Renown Silver HMO $0PCP |
Plan Type | HMO |
Plan Variant Marketing Name | Renown Silver HMO $0PCP_73 |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $3,100 |
SBC Scenario, Having a Baby, Copayment | $50 |
SBC Scenario, Having a Baby, Deductible | $3,700 |
SBC Scenario, Having a Baby, Limit | $20 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $1,700 |
SBC Scenario, Having Diabetes, Deductible | $100 |
SBC Scenario, Having Diabetes, Limit | $200 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,000 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | NVS001 |
Source Name | SERFF |
Specialist Requiring a Referral | All except OB-GYN |
Plan ID | 41094NV0030070 |
State Code | NV |
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 | 50.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $3710 per person | $7420 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,710 |
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 | $7420 per person | $14840 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,420 |
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 |
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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: 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