SLHP Silver 5500 Separate RX Deductible - 44648ID1290015 Health Insurance Plan
Regence BlueShield of Idaho health insurance plan with the Plan ID 44648ID1290015. The plan is called SLHP Silver 5500 Separate RX Deductible.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.10% (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 29.90% 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 | 44648ID1290015 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | Regence BlueShield of Idaho | ||||||||||||||||||
| Health Insurance Plan Variant | 44648ID1290015-03 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 44648ID1290015-01 Open to Indians below 300% FPL - 44648ID1290015-02 Open to Indians above 300% FPL - 44648ID1290015-03 73% AV Silver Plan - 44648ID1290015-04 |
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| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
SLHP Silver 5500 Separate RX Deductible Health Insurance Plan Variant 44648ID1290015-03 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.700996788 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Limited Cost Sharing Plan Variation |
| Drug EHB Deductible, Combined In/Out of Network, Family | $4000 per person | $8000 per group |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $4,000 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $2000 per person | $4000 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| Drug EHB Deductible, Out of Network, Family | $2000 per person | $4000 per group |
| Drug EHB Deductible, Out of Network, Individual | $2,000 |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | IDF007 |
| HIOS Product ID | 44648ID129 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 44648 |
| 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 | $21800 per person | $43600 per group |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $21,800 |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $5500 per person | $11000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $5,500 |
| Medical EHB Deductible, Out of Network, Family | $16300 per person | $32600 per group |
| Medical EHB Deductible, Out of Network, Individual | $16,300 |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | IDN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Members traveling outside the United States receive coverage for the same benefits as inside the United States. Members who do not seek inpatient care at a BlueCross BlueShield Global Hospital may have to pay a provider upfront for care and submit an international claim form to be reimbursed. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of Area benefits are covered on Blue Card which provides access to the largest network of doctors in the United States |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 44648ID1290015-03 |
| Plan Marketing Name | SLHP Silver 5500 Separate RX Deductible |
| Plan Type | PPO |
| Plan Variant Marketing Name | SLHP Silver 5500 Separate RX Deductible |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,300 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $5,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $600 |
| SBC Scenario, Having Diabetes, Copayment | $400 |
| SBC Scenario, Having Diabetes, Deductible | $900 |
| SBC Scenario, Having Diabetes, Limit | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | IDS002 |
| Source Name | SERFF |
| Specialist Requiring a Referral | A provider focusing on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions. |
| Plan ID | 44648ID1290015 |
| State Code | ID |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | $90950 per person | $181900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $90,950 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $9450 per person | $18900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,450 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $81500 per person | $163000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $81,500 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of SLHP Silver 5500 Separate RX Deductible Health Insurance Plan, 44648ID1290015
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about SLHP Silver 5500 Separate RX Deductible, 44648ID1290015 Health Insurance Plan, 44648ID1290015
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Does SLHP Silver 5500 Separate RX Deductible Health Insurance Plan, 44648ID1290015 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (44648ID1290015) Health Insurance Plan, Variant (44648ID1290015-03) have Out Of Country Coverage?
Does (44648ID1290015) Health Insurance Plan, Variant (44648ID1290015-03) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 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