Standard Platinum - Flex - 36046MA0770143 Health Insurance Plan
Harvard Pilgrim Healthcare, Inc. health insurance plan with the Plan ID 36046MA0770143. The plan is called Standard Platinum - Flex.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 90.54% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 9.46% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 36046MA0770143 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Massachusetts | ||||||||||||||||||
| Health Insurance Issuer | Harvard Pilgrim Healthcare, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 36046MA0770143-01 | ||||||||||||||||||
| Provider Network(s) | ['MAN002'] | ||||||||||||||||||
| 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 | |||||||||||||||||||
| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Standard Platinum - Flex Health Insurance Plan Variant 36046MA0770143-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Platinum On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| First Tier Utilization | 100% |
| Formulary ID | MAF006 |
| HIOS Product ID | 36046MA077 |
| HSA/HRA Employer Contribution | No |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 90.54% |
| Issuer ID | 36046 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Platinum |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MAN002 |
| 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) | 36046MA0770143-01 |
| Plan Marketing Name | Standard Platinum - Flex |
| Plan Type | HMO |
| Plan Variant Marketing Name | Standard Platinum - Flex |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $600 |
| 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 | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $50 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| 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 |
| Specialist Requiring a Referral | A referral is needed for all specialists except for OB/GYN, Chiropractic Care, Routine Eye Exams, and Mental Health Providers. |
| Plan ID | 36046MA0770143 |
| State Code | MA |
| 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 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| 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 | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $3000 per person | $6000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $3,000 |
| 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 Standard Platinum - Flex Health Insurance Plan, 36046MA0770143
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Standard Platinum - Flex, 36046MA0770143 Health Insurance Plan, 36046MA0770143
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Does Standard Platinum - Flex Health Insurance Plan, 36046MA0770143 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (36046MA0770143) Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does (36046MA0770143) Health Insurance Plan, Variant (36046MA0770143-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (36046MA0770143) Health Insurance Plan, Variant (36046MA0770143-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan).
Does (36046MA0770143) Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for Asthma?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for Asthma.
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for Heart disease?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for Heart disease.
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for Depression?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for Depression.
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for Diabetes?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for Diabetes.
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for Low back pain?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for Low back pain.
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for Pregnancy?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for Pregnancy.
Does Standard Platinum - Flex Health Insurance Plan, Variant (36046MA0770143-01) offer Disease Management Programs for Weight loss programs?
Yes, the Standard Platinum - Flex Health Insurance Plan Variant
36046MA0770143-01 offers Disease
Management Program for Weight loss programs.
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