UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin) - 45480OK0050035 Health Insurance Plan

UnitedHealthcare of Oklahoma, Inc. health insurance plan with the Plan ID 45480OK0050035. The plan is called UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 65.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 45480OK0050035
Health Insurance Plan Year 2024
State Oklahoma
Health Insurance Issuer UnitedHealthcare of Oklahoma, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 45480OK0050035-00
Provider Network(s) NETWORK NON-PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 GMT).

Providers Oklahoma All US States
All 7114 7589
PCP 615 660
Allergy 2 2
OB/GYN 11 11
Dentists 2 2
Available Variants of the Health Plan

Standard Off Exchange Plan - 45480OK0050035-00

Standard On Exchange Plan - 45480OK0050035-01

Open to Indians below 300% FPL - 45480OK0050035-02

Open to Indians above 300% FPL - 45480OK0050035-03

Last Plan Update Date Tue, 12 Dec 2023 00:00 GMT
Last Import Date Tue, 17 Dec 2024 06:12 GMT

Benefits of UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin) Health Insurance Plan, 45480OK0050035-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited

Exclusions: This exclusion does not apply when the mother's life is endangered.

NO
Accidental Dental
YES

50.00%

100.00%
Acupuncture
NO
Allergy Testing
YES

$100.00

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child

Benefit limitations may apply to individual services.

YES

50.00%

100.00%
Chemotherapy
YES

50.00%

100.00%
Chiropractic Care
YES

50.00%

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Childbirth/delivery professional services follow inpatient physician/surgeon fees.

YES

$3,000.00

100.00%
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

YES

No Charge

100.00%
Diabetes Education
YES

50.00%

100.00%
Dialysis
YES

50.00%

100.00%
Durable Medical Equipment
YES

50.00%

100.00%
Emergency Room Services
YES

$2,250.00

$2,250.00
Emergency Transportation/Ambulance
YES

50.00%

50.00%
Eye Glasses - Adult
NO
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

50.00%

100.00%
Gender Affirming Care
NO
Generic Drugs

Limit: 30.0 Days per Month

90-day supplies are available through retail pharmacies or home delivery.? Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$20.00

100.00%
Habilitation Services

Limit: 25.0 Visit(s) per Year

Limited to 25 visits per year combined for Physical, Occupational and Speech Therapy. Treatment of Autism and Autism Spectrum Disorders are unlimited.

YES

$100.00

100.00%
Hearing Aids

One hearing aid per hearing impaired ear every 48 months for Covered Persons.

YES

50.00%

100.00%
Home Health Care Services

Limit: 30.0 Visit(s) per Year

YES

50.00%

100.00%
Hospice Services
YES

50.00%

100.00%
Imaging (CT/PET Scans, MRIs)
YES

$200.00

100.00%
Infertility Treatment

Exclusions: This exclusion does not apply to diagnosis and services required to treat or correct underlying causes of infertility.

NO
Infusion Therapy

Limit: 25.0 Visit(s) per Year

YES

50.00%

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

$3000 Copay per Day

100.00%
Inpatient Physician and Surgical Services
YES

50.00%

100.00%
Laboratory Outpatient and Professional Services
YES

$20.00

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child

Benefit limitations may apply to individual services.

YES

50.00%

100.00%
Mental/Behavioral Health Inpatient Services
YES

$3000 Copay per Day

100.00%
Mental/Behavioral Health Outpatient Services
YES

$100.00

100.00%
Non-Preferred Brand Drugs

Limit: 30.0 Days per Month

90-day supplies are available through retail pharmacies or home delivery.? Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

48.00% Coinsurance after deductible

100.00%
Nutritional Counseling

Diabetes self-management training and training related to medical nutrition therapy.

YES

50.00%

100.00%
Orthodontia - Adult
NO
Orthodontia - Child

Coverage is for medically necessary orthodontia only.

YES

50.00%

100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

50.00%

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

$375.00

100.00%
Outpatient Rehabilitation Services

Limit: 25.0 Visit(s) per Year

Limited to 25 visits per year combined for Physical, Occupational and Speech Therapy.

YES

$100.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

$375.00

100.00%
Preferred Brand Drugs

Limit: 30.0 Days per Month

90-day supplies are available through retail pharmacies or home delivery.? Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

48.00% Coinsurance after deductible

100.00%
Prenatal and Postnatal Care
YES

No Charge

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

Cost sharing for Virtual Primary Care matches in-person office visit. See SBC for additional cost share details.

YES

$40.00

100.00%
Private-Duty Nursing

Limit: 85.0 Visit(s) per Year

YES

50.00%

100.00%
Prosthetic Devices
YES

50.00%

100.00%
Radiation
YES

50.00%

100.00%
Reconstructive Surgery

Breast reconstruction or implantation or removal of breast prostheses is a Covered Service only when performed solely and directly as a result of mastectomy which is Medically Necessary.

YES

$375.00

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 25.0 Visit(s) per Year

Limited to 25 visits per year combined for Physical, Occupational and Speech Therapy.

YES

$100.00

100.00%
Rehabilitative Speech Therapy

Limit: 25.0 Visit(s) per Year

Limited to 25 visits per year combined for Physical, Occupational and Speech Therapy.

YES

$100.00

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

YES

No Charge

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 30.0 Days per Year

YES

$3000 Copay per Day

100.00%
Specialist Visit
YES

$100.00

100.00%
Specialty Drugs

Limit: 30.0 Days per Month

Covers outpatient self-administered prescription legend drugs from a participating network pharmacy. Quantity limits per prescription may apply.

YES

50% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

$3000 Copay per Day

100.00%
Substance Abuse Disorder Outpatient Services
YES

$100.00

100.00%
Transplant
YES

$3,000.00

100.00%
Treatment for Temporomandibular Joint Disorders
NO
Urgent Care Centers or Facilities

$0 Virtual Urgent Care visits. See SBC for additional cost share details.

YES

$100.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

$100.00

100.00%

UHC Bronze-X Copay Focus $0 Indiv Med Ded ($0 Insulin) Health Insurance Plan Variant 45480OK0050035-00 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person 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 Per Group $9000 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $4500 per person
Drug EHB Deductible, In Network (Tier 1), Individual $4,500
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Design Type Not Applicable
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID OKF004
Formulary URL URL
HIOS Product ID 45480OK005
Import Date 2023-12-12 01:02:02
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 3
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 65.00%
Issuer ID 45480
Issuer Marketplace Marketing Name UnitedHealthcare
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 Per Group per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 50.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Medical EHB Deductible, In Network (Tier 1), Individual $0
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Out of Network, Individual Not Applicable
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID OKN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area.
Plan Brochure URL
Plan Effective Date 2024-01-01
Plan ID (Standard Component ID with Variant) 45480OK0050035-00
Plan Level Exclusions 0
Plan Marketing Name UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin)
Plan Type HMO
Plan Variant Marketing Name UHC Bronze-X Copay Focus $0 Indiv Med Ded ($0 Insulin)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $200
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $500
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 $1,700
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID OKS001
Source Name HIOS
Plan ID 45480OK0050035
State Code OK
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18900 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9450 per person
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 Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin) Health Insurance Plan, 45480OK0050035

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

Frequently Asked Questions(FAQ) about UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin), 45480OK0050035 Health Insurance Plan, 45480OK0050035

  • Does UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Insulin) Health Insurance Plan, 45480OK0050035 support Mail Ordering?

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

  • Does (45480OK0050035) Health Insurance Plan, Variant (45480OK0050035-00) have Out Of Country Coverage?

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

    Does (45480OK0050035) Health Insurance Plan, Variant (45480OK0050035-00) have Out of Service Area Coverage?

    Yes. Details: Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area.

 

Disclaimer: This is based on the import(Date: Tue, 17 Dec 2024 06:12 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