Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP - 74289NY2780072 Health Insurance Plan
Oscar Insurance Corporation health insurance plan with the Plan ID 74289NY2780072. The plan is called Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.89% (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 29.11% 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 | 74289NY2780072 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | New York | ||||||||||||||||||
| Health Insurance Issuer | Oscar Insurance Corporation | ||||||||||||||||||
| Health Insurance Plan Variant | 74289NY2780072-01 | ||||||||||||||||||
| Provider Network(s) | ['NYN002'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 26 Nov 2024 06:27 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, 26 Nov 2024 06:27 GMT |
Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan Variant 74289NY2780072-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.708932888 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Pregnancy, Depression, Diabetes, Heart Disease, Asthma |
| First Tier Utilization | 100% |
| Formulary ID | NYF002 |
| HIOS Product ID | 74289NY278 |
| HSA/HRA Employer Contribution | No |
| Import Date | 2/12/2024 |
| HSA Eligible | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 74289 |
| Market Coverage | SHOP (Small Group) |
| 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 | NYN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency and Urgent Services only |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 74289NY2780072-01 |
| Plan Marketing Name | Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP |
| Plan Type | EPO |
| Plan Variant Marketing Name | Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,400 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $3,250 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $600 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $3,250 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| 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 | NYS002 |
| Source Name | SERFF |
| Plan ID | 74289NY2780072 |
| State Code | NY |
| 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 | 30.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $3250 per person | $6500 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,250 |
| 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 | $6700 per person | $13400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $6,700 |
| 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 | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan, 74289NY2780072
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP, 74289NY2780072 Health Insurance Plan, 74289NY2780072
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Does Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan, 74289NY2780072 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (74289NY2780072) Health Insurance Plan, Variant (74289NY2780072-01) offer Disease Management Programs?
Does (74289NY2780072) Health Insurance Plan, Variant (74289NY2780072-01) have Out Of Country Coverage?
Does (74289NY2780072) Health Insurance Plan, Variant (74289NY2780072-01) have Out of Service Area Coverage?
Does (74289NY2780072) Health Insurance Plan, Variant (74289NY2780072-01) offer Disease Management Programs?
Does Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan, Variant (74289NY2780072-01) offer Disease Management Programs for Asthma?
Does Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan, Variant (74289NY2780072-01) offer Disease Management Programs for Heart disease?
Does Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan, Variant (74289NY2780072-01) offer Disease Management Programs for Depression?
Does Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan, Variant (74289NY2780072-01) offer Disease Management Programs for Diabetes?
Does Silver $3250 HSA, INN, Circle, Pediatric Dental, Dep 25, DP Health Insurance Plan, Variant (74289NY2780072-01) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 26 Nov 2024 06:27 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