Select Plan Premium - 54965VA0020006 Health Insurance Plan
54965 health insurance plan with the Plan ID 54965VA0020006. The plan is called Select Plan Premium.
| Health Insurance Plan ID | 54965VA0020006 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Virginia | ||||||||||||||||||
| Health Insurance Issuer | 54965 | ||||||||||||||||||
| Health Insurance Plan Variant | 54965VA0020006-01 | ||||||||||||||||||
| Provider Network(s) | SELECT | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 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 | Tue, 24 Dec 2024 06:21 GMT |
Select Plan Premium Health Insurance Plan Variant 54965VA0020006-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard High On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 100.00% |
| First Tier Utilization | 100% |
| HIOS Product ID | 54965VA002 |
| Import Date | 2/12/2024 |
| Guaranteed Rate | Guaranteed Rate |
| IsItANewPlan | Existing |
| Issuer ID | 54965 |
| Market Coverage | Individual |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | Not Applicable |
| 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), Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family | $400 per person | $800 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $400 |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual | Not Applicable |
| Metal Level | High |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | VAN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency pain treatment only if 50 miles away from home zip code, up to $100 |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency pain treatment only if 50 miles away from home zip code, up to $100 |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 54965VA0020006-01 |
| Plan Level Exclusions | Co-insurance equivalent percentages displayed except for orthodontic services; copay for orthodontic services will not equal more than out of pocket maximum. Discount provided for non-medically necessary orthodontia. Must choose participating Select Plan dentist. |
| Plan Marketing Name | Select Plan Premium |
| Plan Type | EPO |
| Plan Variant Marketing Name | Select Plan Premium |
| QHP/Non QHP | Both |
| Service Area ID | VAS001 |
| Source Name | SERFF |
| Plan ID | 54965VA0020006 |
| State Code | VA |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Select Plan Premium Health Insurance Plan, 54965VA0020006
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Select Plan Premium, 54965VA0020006 Health Insurance Plan, 54965VA0020006
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Does Select Plan Premium Health Insurance Plan, 54965VA0020006 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (54965VA0020006) Health Insurance Plan, Variant (54965VA0020006-01) have Out Of Country Coverage?
Does (54965VA0020006) Health Insurance Plan, Variant (54965VA0020006-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 24 Dec 2024 06:21 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