Standard High Bronze HSA: WellSense Clarity Bronze 3600 - 82569MA0190001 Health Insurance Plan

WellSense Health Plan health insurance plan with the Plan ID 82569MA0190001. The plan is called Standard High Bronze HSA: WellSense Clarity Bronze 3600.

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 82569MA0190001
Health Insurance Plan Year 2024
State Massachusetts
Health Insurance Issuer WellSense Health Plan
Health Insurance Plan Variant 82569MA0190001-02
Provider Network(s) ['MAN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT).

Providers Massachusetts 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 - 82569MA0190001-01

Open to Indians below 300% FPL - 82569MA0190001-02

Open to Indians above 300% FPL - 82569MA0190001-03

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Thu, 21 Nov 2024 00:44 GMT

Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan Variant 82569MA0190001-02 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
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Pregnancy, High Blood Pressure & High Cholesterol, Heart Disease, Asthma
EHB Percent of Total Premium 99%
First Tier Utilization 100%
Formulary ID MAF006
HIOS Product ID 82569MA019
Import Date 2/12/2024
HSA Eligible Yes
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 82569
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID MAN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency and Urgent Care Only
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 82569MA0190001-02
Plan Level Exclusions No
Plan Marketing Name Standard High Bronze HSA: WellSense Clarity Bronze 3600
Plan Type HMO
Plan Variant Marketing Name Standard High Bronze HSA: WellSense Clarity Bronze 3600
QHP/Non QHP Both
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 $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $0
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 $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MAS001
Source Name SERFF
Plan ID 82569MA0190001
State Code MA
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
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family $0 per person | $0 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $0
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $0 per person | $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
TEHBDedOutofNetFamily $0 per person | $0 per group
Combined Medical and Drug EHB Deductible, Out of 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 No
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan, 82569MA0190001

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

Frequently Asked Questions(FAQ) about Standard High Bronze HSA: WellSense Clarity Bronze 3600, 82569MA0190001 Health Insurance Plan, 82569MA0190001

  • Does Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan, 82569MA0190001 support Mail Ordering?

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

    • Does (82569MA0190001) Health Insurance Plan, Variant (82569MA0190001-02) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Heart Disease, Asthma

    Does (82569MA0190001) Health Insurance Plan, Variant (82569MA0190001-02) have Out Of Country Coverage?

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

    Does (82569MA0190001) Health Insurance Plan, Variant (82569MA0190001-02) have Out of Service Area Coverage?

    Yes. Details: Emergency and Urgent Care Only

    Does (82569MA0190001) Health Insurance Plan, Variant (82569MA0190001-02) offer Disease Management Programs?

    Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Heart Disease, Asthma

    Does Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan, Variant (82569MA0190001-02) offer Disease Management Programs for Asthma?

    Yes, the Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan Variant 82569MA0190001-02 offers Disease Management Program for Asthma.

    Does Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan, Variant (82569MA0190001-02) offer Disease Management Programs for Heart disease?

    Yes, the Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan Variant 82569MA0190001-02 offers Disease Management Program for Heart disease.

    Does Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan, Variant (82569MA0190001-02) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan Variant 82569MA0190001-02 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan, Variant (82569MA0190001-02) offer Disease Management Programs for Pregnancy?

    Yes, the Standard High Bronze HSA: WellSense Clarity Bronze 3600 Health Insurance Plan Variant 82569MA0190001-02 offers Disease Management Program for Pregnancy.

 

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