Trio Bronze 60 HMO 7000/70 + Child Dental Alt - 70285CA8230138 Health Insurance Plan
California Physicians' Service, dba Blue Shield of California health insurance plan with the Plan ID 70285CA8230138. The plan is called Trio Bronze 60 HMO 7000/70 + Child Dental Alt.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.67% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.33% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 70285CA8230138 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | California | ||||||||||||||||||
| Health Insurance Issuer | California Physicians' Service, dba Blue Shield of California | ||||||||||||||||||
| Health Insurance Plan Variant | 70285CA8230138-01 | ||||||||||||||||||
| Provider Network(s) | ['CAN010'] | ||||||||||||||||||
| 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 |
Trio Bronze 60 HMO 7000/70 + Child Dental Alt Health Insurance Plan Variant 70285CA8230138-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze On Exchange Plan |
| Dental Only Plan | No |
| First Tier Utilization | 100% |
| Formulary ID | CAF010 |
| HIOS Product ID | 70285CA823 |
| HSA/HRA Employer Contribution | No |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 64.67% |
| Issuer ID | 70285 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | CAN010 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 70285CA8230138-01 |
| Plan Marketing Name | Trio Bronze 60 HMO 7000/70 + Child Dental Alt |
| Plan Type | HMO |
| Plan Variant Marketing Name | Trio Bronze 60 HMO 7000/70 + Child Dental Alt |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $2,000 |
| SBC Scenario, Having a Baby, Copayment | $800 |
| SBC Scenario, Having a Baby, Deductible | $6,300 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $400 |
| SBC Scenario, Having Diabetes, Copayment | $2,400 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $700 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,700 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 0% |
| Service Area ID | CAS034 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician. |
| Specialty Drug Maximum Coinsurance | $500 |
| Plan ID | 70285CA8230138 |
| State Code | CA |
| 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 | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $7000 per person | $14000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,000 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | Not Applicable |
| 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 | $9100 per person | $18200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family | $0 per person | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $0 |
| 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 Trio Bronze 60 HMO 7000/70 + Child Dental Alt Health Insurance Plan, 70285CA8230138
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Trio Bronze 60 HMO 7000/70 + Child Dental Alt, 70285CA8230138 Health Insurance Plan, 70285CA8230138
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Does Trio Bronze 60 HMO 7000/70 + Child Dental Alt Health Insurance Plan, 70285CA8230138 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (70285CA8230138) Health Insurance Plan, Variant (70285CA8230138-01) have Out Of Country Coverage?
Does (70285CA8230138) Health Insurance Plan, Variant (70285CA8230138-01) 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