UHC Gold Virtual Access (Unlimited $0 Virtual) - 72375MD0070017 Health Insurance Plan
Optimum Choice, Inc. health insurance plan with the Plan ID 72375MD0070017. The plan is called UHC Gold Virtual Access (Unlimited $0 Virtual).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.02% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.98% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 72375MD0070017 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Maryland | ||||||||||||||||||
| Health Insurance Issuer | Optimum Choice, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 72375MD0070017-03 | ||||||||||||||||||
| 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 | Standard On Exchange Plan - 72375MD0070017-01 |
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| Last Plan Update Date | Fri, 31 May 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
UHC Gold-B Virtual Access (Unlimited $0 Virtual) Health Insurance Plan Variant 72375MD0070017-03 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 | 99% |
| First Tier Utilization | 99% |
| Formulary ID | MDF009 |
| HIOS Product ID | 72375MD007 |
| Import Date | 5/31/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 78.02% |
| Issuer ID | 72375 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | MDN002 |
| 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) | 72375MD0070017-03 |
| Plan Level Exclusions | 0 |
| Plan Marketing Name | UHC Gold Virtual Access (Unlimited $0 Virtual) |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC Gold-B Virtual Access (Unlimited $0 Virtual) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,100 |
| SBC Scenario, Having a Baby, Copayment | $100 |
| SBC Scenario, Having a Baby, Deductible | $1,100 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $300 |
| SBC Scenario, Having Diabetes, Deductible | $1,100 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 0% |
| Service Area ID | MDS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All, except OBGYN and as state mandated |
| Plan ID | 72375MD0070017 |
| 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 | 25.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $1100 per person | $2200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,100 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 25.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family | $1100 per person | $2200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $1,100 |
| 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 | $8400 per person | $16800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,400 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family | $8400 per person | $16800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $8,400 |
| 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 Virtual Access (Unlimited $0 Virtual) Health Insurance Plan, 72375MD0070017
| 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 Virtual Access (Unlimited $0 Virtual), 72375MD0070017 Health Insurance Plan, 72375MD0070017
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Does UHC Gold Virtual Access (Unlimited $0 Virtual) Health Insurance Plan, 72375MD0070017 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (72375MD0070017) Health Insurance Plan, Variant (72375MD0070017-03) have Out Of Country Coverage?
Does (72375MD0070017) Health Insurance Plan, Variant (72375MD0070017-03) have Out of Service Area Coverage?
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