UHC Choice HSA Bronze 7100-2 - 65635MD0060001 Health Insurance Plan
MAMSI Life and Health Insurance Company health insurance plan with the Plan ID 65635MD0060001. The plan is called UHC Choice HSA Bronze 7100-2.
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 | 65635MD0060001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Maryland | ||||||||||||||||||
| Health Insurance Issuer | MAMSI Life and Health Insurance Company | ||||||||||||||||||
| Health Insurance Plan Variant | 65635MD0060001-01 | ||||||||||||||||||
| Provider Network(s) | ['MDN002'] | ||||||||||||||||||
| 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 | Fri, 31 May 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
UHC Choice HSA Bronze 7100-2 Health Insurance Plan Variant 65635MD0060001-01 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 |
| Disease Management Programs Offered | Pregnancy, Diabetes, Heart Disease |
| First Tier Utilization | 100% |
| Formulary ID | MDF013 |
| HIOS Product ID | 65635MD006 |
| HSA/HRA Employer Contribution | No |
| Import Date | 5/31/2024 |
| HSA Eligible | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 65.00% |
| Issuer ID | 65635 |
| 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 | No |
| National Network | No |
| Network ID | MDN002 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 65635MD0060001-01 |
| Plan Level Exclusions | No |
| Plan Marketing Name | UHC Choice HSA Bronze 7100-2 |
| Plan Type | EPO |
| Plan Variant Marketing Name | UHC Choice HSA Bronze 7100-2 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $7,100 |
| 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 | MDS002 |
| Source Name | SERFF |
| Plan ID | 65635MD0060001 |
| State Code | MD |
| 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 | $7100 per person | $14200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,100 |
| 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 | $7100 per person | $14200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,100 |
| 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 Choice HSA Bronze 7100-2 Health Insurance Plan, 65635MD0060001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about UHC Choice HSA Bronze 7100-2, 65635MD0060001 Health Insurance Plan, 65635MD0060001
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Does UHC Choice HSA Bronze 7100-2 Health Insurance Plan, 65635MD0060001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (65635MD0060001) Health Insurance Plan, Variant (65635MD0060001-01) offer Disease Management Programs?
Does (65635MD0060001) Health Insurance Plan, Variant (65635MD0060001-01) have Out Of Country Coverage?
Does (65635MD0060001) Health Insurance Plan, Variant (65635MD0060001-01) have Out of Service Area Coverage?
Does (65635MD0060001) Health Insurance Plan, Variant (65635MD0060001-01) offer Disease Management Programs?
Does UHC Choice HSA Bronze 7100-2 Health Insurance Plan, Variant (65635MD0060001-01) offer Disease Management Programs for Heart disease?
Does UHC Choice HSA Bronze 7100-2 Health Insurance Plan, Variant (65635MD0060001-01) offer Disease Management Programs for Diabetes?
Does UHC Choice HSA Bronze 7100-2 Health Insurance Plan, Variant (65635MD0060001-01) offer Disease Management Programs 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