Aetna Health Inc. (a PA corp.) health insurance plan with the Plan ID 66516MD0080011. The plan is called Silver Value: Aetna Network + $0 MinuteClinic + $0 CVS Health Virtual Care.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.49% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.51% of the costs of all covered benefits (according to the Issuer).
Health Insurance Plan ID | 66516MD0080011 | ||||||||||||||||||
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Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Maryland | ||||||||||||||||||
Health Insurance Issuer | Aetna Health Inc. (a PA corp.) | ||||||||||||||||||
Health Insurance Plan Variant | 66516MD0080011-01 | ||||||||||||||||||
Provider Network(s) | NON-PREFERRED PREFERRED | ||||||||||||||||||
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 | Standard On Exchange Plan - 66516MD0080011-01 Open to Indians below 300% FPL - 66516MD0080011-02 Open to Indians above 300% FPL - 66516MD0080011-03 73% AV Silver Plan - 66516MD0080011-04 |
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Last Plan Update Date | Fri, 31 May 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 26 Nov 2024 06:27 GMT |
Plan Attribute | Value |
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Business Year | 2024 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard Silver On Exchange Plan |
Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family | per person not applicable | per group not applicable |
Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Individual | Not Applicable |
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 | 0.00% |
Drug EHB Deductible, In Network (Tier 1), Family | $750 per person | $1500 per group |
Drug EHB Deductible, In Network (Tier 1), Individual | $750 |
Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
Drug EHB Deductible, Out of Network, Individual | Not Applicable |
Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual | $1,500 |
Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Individual | $1500 per person | $3000 per group |
Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family | per person not applicable | per group not applicable |
Maximum Out of Pocket for Drug EHB Benefits, 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 | 99% |
First Tier Utilization | 100% |
Formulary ID | MDF019 |
HIOS Product ID | 66516MD008 |
Import Date | 5/31/2024 |
HSA Eligible | No |
IsItANewPlan | New |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | Yes |
Issuer Actuarial Value | 71.49% |
Issuer ID | 66516 |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | No |
Medical Drug Maximum Out of Pocket Integrated | No |
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), Default Coinsurance | 30.00% |
Medical EHB Deductible, In Network (Tier 1), Family | $4500 per person | $9000 per group |
Medical EHB Deductible, In Network (Tier 1), Individual | $4,500 |
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 | $7600 per person | $15200 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $7,600 |
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 | Silver |
Multiple In Network Tiers | No |
National Network | No |
Network ID | MDN001 |
Out of Country Coverage | No |
Out of Service Area Coverage | No |
Out of Service Area Coverage Description | Except for Emergencies |
Plan Effective Date | 1/1/2024 |
Plan ID (Standard Component ID with Variant) | 66516MD0080011-01 |
Plan Marketing Name | Silver Value: Aetna Network + $0 MinuteClinic + $0 CVS Health Virtual Care |
Plan Type | HMO |
Plan Variant Marketing Name | Silver Value: Aetna Network + $0 MinuteClinic + $0 CVS Health Virtual Care |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $0 |
SBC Scenario, Having a Baby, Copayment | $1,100 |
SBC Scenario, Having a Baby, Deductible | $4,500 |
SBC Scenario, Having a Baby, Limit | $60 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $1,900 |
SBC Scenario, Having Diabetes, Deductible | $800 |
SBC Scenario, Having Diabetes, Limit | $20 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,000 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | MDS001 |
Source Name | SERFF |
Specialist Requiring a Referral | Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician. |
Plan ID | 66516MD0080011 |
State Code | MD |
Unique Plan Design | Yes |
Version Number | 1 |
Wellness Program Offered | Yes |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
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