Select Health SLHP Silver 4000 - $0 copay for PCP visits - 26002ID0010009 Health Insurance Plan
SelectHealth health insurance plan with the Plan ID 26002ID0010009. The plan is called Select Health SLHP Silver 4000 - $0 copay for PCP visits .
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 87.45% (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 12.55% 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 | 26002ID0010009 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | SelectHealth | ||||||||||||||||||
| Health Insurance Plan Variant | 26002ID0010009-05 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| 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 - 26002ID0010009-01 Open to Indians below 300% FPL - 26002ID0010009-02 Open to Indians above 300% FPL - 26002ID0010009-03 73% AV Silver Plan - 26002ID0010009-04 |
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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 |
Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan Variant 26002ID0010009-05 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.874462146 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 87% AV Level Silver Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | $250 per person | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $250 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 30.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
| 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, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | IDF008 |
| HIOS Product ID | 26002ID001 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 26002 |
| 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 | 30.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $700 per person | $1400 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $700 |
| Medical EHB Deductible, Out of Network, Family | $18200 per person | $36400 per group |
| Medical EHB Deductible, Out of Network, Individual | $18,200 |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | IDN001 |
| Out of Country Coverage | No |
| Out of Country Coverage Description | All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 26002ID0010009-05 |
| Plan Level Exclusions | Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Administrative Services/Charges; Certain Allergy Tests; Bariatric Surgery; Biofeedback/Neurofeedback; Certain Cancer Therapies; Certain Illegal Activities; Claims After One Year; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Debarred Providers; Dental Anesthesia where criteria is not met; Duplication of Coverage; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gene Therapy; Hearing Aids where criteria is not met; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Travel-Related Expenses; computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Oncofertility; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items. |
| Plan Marketing Name | Select Health SLHP Silver 4000 - $0 copay for PCP visits |
| Plan Type | PPO |
| Plan Variant Marketing Name | Select Health SLHP Silver 4000 - $0 copay for PCP visits |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,000 |
| SBC Scenario, Having a Baby, Copayment | $300 |
| SBC Scenario, Having a Baby, Deductible | $700 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $30 |
| SBC Scenario, Having Diabetes, Copayment | $400 |
| SBC Scenario, Having Diabetes, Deductible | $700 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $900 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $700 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | IDS001 |
| Source Name | SERFF |
| Plan ID | 26002ID0010009 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $3000 per person | $6000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $3,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $91000 per person | $182000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $91,000 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, 26002ID0010009
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Select Health SLHP Silver 4000 - $0 copay for PCP visits , 26002ID0010009 Health Insurance Plan, 26002ID0010009
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Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, 26002ID0010009 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (26002ID0010009) Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs?
Does (26002ID0010009) Health Insurance Plan, Variant (26002ID0010009-05) have Out Of Country Coverage?
Does (26002ID0010009) Health Insurance Plan, Variant (26002ID0010009-05) have Out of Service Area Coverage?
Does (26002ID0010009) Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs?
Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs for Asthma?
Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs for Heart disease?
Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs for Depression?
Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs for Diabetes?
Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, Variant (26002ID0010009-05) offer Disease Management Programs for Low back pain?
Does Select Health SLHP Silver 4000 - $0 copay for PCP visits Health Insurance Plan, Variant (26002ID0010009-05) 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