UHC Choice Plus HSA Gold 2500-1 - 41842DC0080023 Health Insurance Plan
UnitedHealthcare Insurance Company health insurance plan with the Plan ID 41842DC0080023. The plan is called UHC Choice Plus HSA Gold 2500-1.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.70% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.30% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 41842DC0080023 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | District of Columbia | ||||||||||||||||||
| Health Insurance Issuer | UnitedHealthcare Insurance Company | ||||||||||||||||||
| Health Insurance Plan Variant | 41842DC0080023-01 | ||||||||||||||||||
| Provider Network(s) | ['DCN001'] | ||||||||||||||||||
| 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 |
UHC Choice Plus HSA Gold 2500-1 Health Insurance Plan Variant 41842DC0080023-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Pregnancy, Diabetes, Heart Disease |
| First Tier Utilization | 100% |
| Formulary ID | DCF019 |
| HIOS Product ID | 41842DC008 |
| HSA/HRA Employer Contribution | Yes |
| HSA/HRA Employer Contribution Amount | $250.00 |
| Import Date | 2/12/2024 |
| HSA Eligible | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 81.70% |
| Issuer ID | 41842 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | DCN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Yes, enter With Network Provider, same as other Network Benefits |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 41842DC0080023-01 |
| Plan Level Exclusions | No |
| Plan Marketing Name | UHC Choice Plus HSA Gold 2500-1 |
| Plan Type | POS |
| Plan Variant Marketing Name | UHC Choice Plus HSA Gold 2500-1 |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $10 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $2,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $30 |
| SBC Scenario, Having Diabetes, Copayment | $100 |
| SBC Scenario, Having Diabetes, Deductible | $2,500 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $30 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | DCS001 |
| Source Name | SERFF |
| Plan ID | 41842DC0080023 |
| State Code | DC |
| 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 | 10.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | per person not applicable | $5000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,500 |
| TEHBDedOutofNetFamily | per person not applicable | $12000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $6,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $8700 per person | $8700 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $4,350 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $20000 per person | $20000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $10,000 |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of UHC Choice Plus HSA Gold 2500-1 Health Insurance Plan, 41842DC0080023
| 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 Plus HSA Gold 2500-1, 41842DC0080023 Health Insurance Plan, 41842DC0080023
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Does UHC Choice Plus HSA Gold 2500-1 Health Insurance Plan, 41842DC0080023 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (41842DC0080023) Health Insurance Plan, Variant (41842DC0080023-01) offer Disease Management Programs?
Does (41842DC0080023) Health Insurance Plan, Variant (41842DC0080023-01) have Out Of Country Coverage?
Does (41842DC0080023) Health Insurance Plan, Variant (41842DC0080023-01) have Out of Service Area Coverage?
Does (41842DC0080023) Health Insurance Plan, Variant (41842DC0080023-01) offer Disease Management Programs?
Does UHC Choice Plus HSA Gold 2500-1 Health Insurance Plan, Variant (41842DC0080023-01) offer Disease Management Programs for Heart disease?
Does UHC Choice Plus HSA Gold 2500-1 Health Insurance Plan, Variant (41842DC0080023-01) offer Disease Management Programs for Diabetes?
Does UHC Choice Plus HSA Gold 2500-1 Health Insurance Plan, Variant (41842DC0080023-01) 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