UHC OCI HSA Silver 5500 - 75753DC0030024 Health Insurance Plan
Optimum Choice, Inc. health insurance plan with the Plan ID 75753DC0030024. The plan is called UHC OCI HSA Silver 5500.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.90% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.10% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 75753DC0030024 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | District of Columbia | ||||||||||||||||||
| Health Insurance Issuer | Optimum Choice, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 75753DC0030024-01 | ||||||||||||||||||
| 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 OCI HSA Silver 5500 Health Insurance Plan Variant 75753DC0030024-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Pregnancy, Diabetes, Heart Disease |
| First Tier Utilization | 100% |
| Formulary ID | DCF011 |
| HIOS Product ID | 75753DC003 |
| HSA/HRA Employer Contribution | Yes |
| HSA/HRA Employer Contribution Amount | $200.00 |
| Import Date | 2/12/2024 |
| HSA Eligible | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 71.90% |
| Issuer ID | 75753 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | DCN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Effective Date | 1/1/2024 |
| Plan ID (Standard Component ID with Variant) | 75753DC0030024-01 |
| Plan Marketing Name | UHC OCI HSA Silver 5500 |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC OCI HSA Silver 5500 |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $5,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $900 |
| 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 | DCS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All, except OBGYN and as state mandated |
| Plan ID | 75753DC0030024 |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $5500 per person | $11000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $5,500 |
| 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 | $7350 per person | $14700 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,350 |
| 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 OCI HSA Silver 5500 Health Insurance Plan, 75753DC0030024
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about UHC OCI HSA Silver 5500, 75753DC0030024 Health Insurance Plan, 75753DC0030024
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Does UHC OCI HSA Silver 5500 Health Insurance Plan, 75753DC0030024 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (75753DC0030024) Health Insurance Plan, Variant (75753DC0030024-01) offer Disease Management Programs?
Does (75753DC0030024) Health Insurance Plan, Variant (75753DC0030024-01) have Out Of Country Coverage?
Does (75753DC0030024) Health Insurance Plan, Variant (75753DC0030024-01) have Out of Service Area Coverage?
Does (75753DC0030024) Health Insurance Plan, Variant (75753DC0030024-01) offer Disease Management Programs?
Does UHC OCI HSA Silver 5500 Health Insurance Plan, Variant (75753DC0030024-01) offer Disease Management Programs for Heart disease?
Does UHC OCI HSA Silver 5500 Health Insurance Plan, Variant (75753DC0030024-01) offer Disease Management Programs for Diabetes?
Does UHC OCI HSA Silver 5500 Health Insurance Plan, Variant (75753DC0030024-01) 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