Silver 70 HMO - 84014CA0010003 Health Insurance Plan

County of Santa Clara dba Valley Health Plan health insurance plan with the Plan ID 84014CA0010003. The plan is called Silver 70 HMO.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 94.74% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 5.26% 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 96.57% (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 3.43% 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 84014CA0010003
Health Insurance Plan Year 2024
State California
Health Insurance Issuer County of Santa Clara dba Valley Health Plan
Health Insurance Plan Variant 84014CA0010003-06
Provider Network(s) ['CAN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 GMT).

Providers California All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard On Exchange Plan - 84014CA0010003-01

Open to Indians below 300% FPL - 84014CA0010003-02

Open to Indians above 300% FPL - 84014CA0010003-03

73% AV Silver Plan - 84014CA0010003-04

87% AV Silver Plan - 84014CA0010003-05

94% AV Silver Plan - 84014CA0010003-06

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 24 Dec 2024 06:21 GMT

Silver 94 HMO Health Insurance Plan Variant 84014CA0010003-06 Attributes

Plan Attribute Value
AV Calculator Output Number 0.965681529
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type 94% AV Level Silver Plan
Drug EHB Deductible, Combined In/Out of Network, Family per person not applicable | per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 10.00%
Drug EHB Deductible, In Network (Tier 1), Family $0 per person | $0 per group
Drug EHB Deductible, In Network (Tier 1), Individual $0
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
EHB Percent of Total Premium 99%
First Tier Utilization 100%
Formulary ID CAF003
HIOS Product ID 84014CA001
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy Yes
Is a Referral Required for Specialist? Yes
Issuer Actuarial Value 94.74%
Issuer ID 84014
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 10.00%
Medical EHB Deductible, In Network (Tier 1), Family $0 per person | $0 per group
Medical EHB Deductible, In Network (Tier 1), Individual $0
Medical EHB Deductible, Out of Network, Family per person not applicable | per group not applicable
Medical EHB Deductible, Out of Network, Individual Not Applicable
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID CAN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 84014CA0010003-06
Plan Marketing Name Silver 70 HMO
Plan Type HMO
Plan Variant Marketing Name Silver 94 HMO
QHP/Non QHP On the Exchange
SBC Scenario, Having a Baby, Coinsurance $1,000
SBC Scenario, Having a Baby, Copayment $200
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $80
SBC Scenario, Having Diabetes, Copayment $300
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $40
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID CAS001
Source Name SERFF
Specialist Requiring a Referral All
Specialty Drug Maximum Coinsurance $150
Plan ID 84014CA0010003
State Code CA
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 $1150 per person | $2300 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $1,150
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

Copay & Coinsurance of Silver 70 HMO Health Insurance Plan, 84014CA0010003

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Silver 70 HMO, 84014CA0010003 Health Insurance Plan, 84014CA0010003

  • Does Silver 70 HMO Health Insurance Plan, 84014CA0010003 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (84014CA0010003) Health Insurance Plan, Variant (84014CA0010003-06) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (84014CA0010003) Health Insurance Plan, Variant (84014CA0010003-06) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

 

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