UHC Gold Advantage+ (Dental + Vision) - 24251VA0070002 Health Insurance Plan
Optimum Choice, Inc health insurance plan with the Plan ID 24251VA0070002. The plan is called UHC Gold Advantage+ (Dental + Vision).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.55% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.45% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 24251VA0070002 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Virginia | ||||||||||||||||||
| Health Insurance Issuer | Optimum Choice, Inc | ||||||||||||||||||
| Health Insurance Plan Variant | 24251VA0070002-03 | ||||||||||||||||||
| 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). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 24251VA0070002-01 |
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| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 24 Dec 2024 06:21 GMT |
UHC Gold-B Advantage+ (Dental + Vision) Health Insurance Plan Variant 24251VA0070002-03 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 | 93% |
| First Tier Utilization | 100% |
| Formulary ID | VAF012 |
| HIOS Product ID | 24251VA007 |
| 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 | 78.55% |
| Issuer ID | 24251 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| 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) | 24251VA0070002-03 |
| Plan Level Exclusions | 0 |
| Plan Marketing Name | UHC Gold Advantage+ (Dental + Vision) |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC Gold-B Advantage+ (Dental + Vision) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,700 |
| SBC Scenario, Having a Baby, Copayment | $100 |
| SBC Scenario, Having a Baby, Deductible | $1,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $200 |
| SBC Scenario, Having Diabetes, Deductible | $1,500 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $90 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | VAS001 |
| Source Name | SERFF |
| Plan ID | 24251VA0070002 |
| 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 | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $1500 per person | $3000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,500 |
| 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 | $7000 per person | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,000 |
| 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 Gold Advantage+ (Dental + Vision) Health Insurance Plan, 24251VA0070002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about UHC Gold Advantage+ (Dental + Vision), 24251VA0070002 Health Insurance Plan, 24251VA0070002
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Does UHC Gold Advantage+ (Dental + Vision) Health Insurance Plan, 24251VA0070002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (24251VA0070002) Health Insurance Plan, Variant (24251VA0070002-03) have Out Of Country Coverage?
Does (24251VA0070002) Health Insurance Plan, Variant (24251VA0070002-03) have Out of Service Area Coverage?
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