UHC Bronze Value HSA - 24251VA0060034 Health Insurance Plan

Optimum Choice, Inc health insurance plan with the Plan ID 24251VA0060034. The plan is called UHC Bronze Value HSA.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 63.20% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 36.80% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 24251VA0060034
Health Insurance Plan Year 2024
State Virginia
Health Insurance Issuer Optimum Choice, Inc
Health Insurance Plan Variant 24251VA0060034-03
Provider Network(s) NON-PREFERRED NETWORK
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 GMT).

Providers Virginia All US States
All 20555 31480
PCP 2785 4216
Allergy 12 19
OB/GYN 96 182
Dentists 13 21
Available Variants of the Health Plan

Standard On Exchange Plan - 24251VA0060034-01

Open to Indians below 300% FPL - 24251VA0060034-02

Open to Indians above 300% FPL - 24251VA0060034-03

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 24 Dec 2024 06:21 GMT

UHC Bronze-B Value Health Insurance Plan Variant 24251VA0060034-03 Attributes

Plan Attribute Value
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Limited Cost Sharing Plan Variation
Dental Only Plan No
Design Type Not Applicable
EHB Percent of Total Premium 100%
First Tier Utilization 100%
Formulary ID VAF002
HIOS Product ID 24251VA006
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 63.20%
Issuer ID 24251
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 VAN001
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. The Network Area may include select Network providers located in a neighboring state
Plan Effective Date 1/1/2024
Plan ID (Standard Component ID with Variant) 24251VA0060034-03
Plan Level Exclusions 0
Plan Marketing Name UHC Bronze Value HSA
Plan Type HMO
Plan Variant Marketing Name UHC Bronze-B Value
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 $6,700
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,400
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 $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID VAS001
Source Name SERFF
Plan ID 24251VA0060034
State Code VA
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 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $6700 per person | $13400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,700
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 $8050 per person | $16100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,050
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 No

Copay & Coinsurance of UHC Bronze Value HSA Health Insurance Plan, 24251VA0060034

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

Frequently Asked Questions(FAQ) about UHC Bronze Value HSA, 24251VA0060034 Health Insurance Plan, 24251VA0060034

  • Does UHC Bronze Value HSA Health Insurance Plan, 24251VA0060034 support Mail Ordering?

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

  • Does (24251VA0060034) Health Insurance Plan, Variant (24251VA0060034-03) have Out Of Country Coverage?

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

    Does (24251VA0060034) Health Insurance Plan, Variant (24251VA0060034-03) 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. The Network Area may include select Network providers located in a neighboring state

 

Disclaimer: This is based on the import(Date: Tue, 24 Dec 2024 06:21 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