Silver PPO Standard Pathway - 86545CT1330001 Health Insurance Plan

Anthem Health Plans, Inc. health insurance plan with the Plan ID 86545CT1330001. The plan is called Silver PPO Standard Pathway.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 100.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 0.00% 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 100.00% (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 0.00% 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 86545CT1330001
Health Insurance Plan Year 2024
State Connecticut
Health Insurance Issuer Anthem Health Plans, Inc.
Health Insurance Plan Variant 86545CT1330001-02
Provider Network(s) ['CTN002']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Connecticut 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 - 86545CT1330001-01

Open to Indians below 300% FPL - 86545CT1330001-02

Open to Indians above 300% FPL - 86545CT1330001-03

73% AV Silver Plan - 86545CT1330001-04

87% AV Silver Plan - 86545CT1330001-05

94% AV Silver Plan - 86545CT1330001-06

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Silver PPO Standard Pathway ZCSR Health Insurance Plan Variant 86545CT1330001-02 Attributes

Plan Attribute Value
AV Calculator Output Number 1
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Zero Cost Sharing Plan Variation
Drug EHB Deductible, Combined In/Out of Network, Family $0 per person | $0 per group
Drug EHB Deductible, Combined In/Out of Network, Individual $0
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
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 $0 per person | $0 per group
Drug EHB Deductible, Out of Network, Individual $0
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
EHB Percent of Total Premium 99%
First Tier Utilization 100%
Formulary ID CTF112
HIOS Product ID 86545CT133
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 100.00%
Issuer ID 86545
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 $0 per person | $0 per group
Medical EHB Deductible, Combined In/Out of Network, Individual $0
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
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 $0 per person | $0 per group
Medical EHB Deductible, Out of Network, Individual $0
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID CTN002
Out of Country Coverage No
Out of Country Coverage Description Emergency Coverage Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description TRAD/PAR network
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 86545CT1330001-02
Plan Marketing Name Silver PPO Standard Pathway
Plan Type PPO
Plan Variant Marketing Name Silver PPO Standard Pathway ZCSR
QHP/Non QHP On the Exchange
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
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 $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID CTS001
Source Name SERFF
Plan ID 86545CT1330001
State Code CT
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family $0 per person | $0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $0
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $0 per person | $0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $0
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $0 per person | $0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $0
Unique Plan Design Yes
Version Number 1
Wellness Program Offered No

Copay & Coinsurance of Silver PPO Standard Pathway Health Insurance Plan, 86545CT1330001

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

Frequently Asked Questions(FAQ) about Silver PPO Standard Pathway, 86545CT1330001 Health Insurance Plan, 86545CT1330001

  • Does Silver PPO Standard Pathway Health Insurance Plan, 86545CT1330001 support Mail Ordering?

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

  • Does (86545CT1330001) Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs?

    Yes, and here is the list of available programs: High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma

    Does (86545CT1330001) Health Insurance Plan, Variant (86545CT1330001-02) have Out Of Country Coverage?

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

    Does (86545CT1330001) Health Insurance Plan, Variant (86545CT1330001-02) have Out of Service Area Coverage?

    Yes. Details: TRAD/PAR network

    Does (86545CT1330001) Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs?

    Yes, and here is the list of available programs: High Blood Pressure & High Cholesterol, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma

    Does Silver PPO Standard Pathway ZCSR Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs for Asthma?

    Yes, the Silver PPO Standard Pathway ZCSR Health Insurance Plan Variant 86545CT1330001-02 offers Disease Management Program for Asthma.

    Does Silver PPO Standard Pathway ZCSR Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs for Heart disease?

    Yes, the Silver PPO Standard Pathway ZCSR Health Insurance Plan Variant 86545CT1330001-02 offers Disease Management Program for Heart disease.

    Does Silver PPO Standard Pathway ZCSR Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs for Depression?

    Yes, the Silver PPO Standard Pathway ZCSR Health Insurance Plan Variant 86545CT1330001-02 offers Disease Management Program for Depression.

    Does Silver PPO Standard Pathway ZCSR Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs for Diabetes?

    Yes, the Silver PPO Standard Pathway ZCSR Health Insurance Plan Variant 86545CT1330001-02 offers Disease Management Program for Diabetes.

    Does Silver PPO Standard Pathway ZCSR Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Silver PPO Standard Pathway ZCSR Health Insurance Plan Variant 86545CT1330001-02 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Silver PPO Standard Pathway ZCSR Health Insurance Plan, Variant (86545CT1330001-02) offer Disease Management Programs for Low back pain?

    Yes, the Silver PPO Standard Pathway ZCSR Health Insurance Plan Variant 86545CT1330001-02 offers Disease Management Program for Low back pain.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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