UHC Silver Standard - 40702AZ0060018 Health Insurance Plan

UnitedHealthcare of Arizona, Inc. health insurance plan with the Plan ID 40702AZ0060018. The plan is called UHC Silver Standard.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 94.14% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 5.86% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 40702AZ0060018
Health Insurance Plan Year 2025
State Arizona
Health Insurance Issuer UnitedHealthcare of Arizona, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 40702AZ0060018-06
Provider Network(s) NON-PREFERRED NETWORK
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT).

Providers Arizona All US States
All 16221 18814
PCP 2083 2290
Allergy 4 4
OB/GYN 92 101
Dentists 35 38
Available Variants of the Health Plan

Standard Off Exchange Plan - 40702AZ0060018-00

Standard On Exchange Plan - 40702AZ0060018-01

Open to Indians below 300% FPL - 40702AZ0060018-02

Open to Indians above 300% FPL - 40702AZ0060018-03

73% AV Silver Plan - 40702AZ0060018-04

87% AV Silver Plan - 40702AZ0060018-05

94% AV Silver Plan - 40702AZ0060018-06

Last Plan Update Date Fri, 16 Aug 2024 00:00 GMT
Last Import Date Thu, 21 Nov 2024 00:44 GMT

Benefits of UHC Silver Standard Health Insurance Plan, 40702AZ0060018-06

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
YES

25.00%

100.00%
Acupuncture
NO
Allergy Testing
YES

$10.00

100.00%
Bariatric Surgery
YES

25.00%

100.00%
Basic Dental Care - Adult
NO
Basic Dental Care - Child

Benefit limitations may apply to individual services.

YES

25.00%

100.00%
Chemotherapy
YES

25.00%

100.00%
Chiropractic Care

Limit: 20.0 Visit(s) per Year

YES

25.00%

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

25.00%

100.00%
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

YES

No Charge

100.00%
Diabetes Education
YES

25.00%

100.00%
Dialysis
YES

25.00%

100.00%
Durable Medical Equipment
YES

25.00%

100.00%
Emergency Room Services
YES

25.00%

25.00%
Emergency Transportation/Ambulance
YES

25.00%

25.00%
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

25.00%

100.00%
Gender Affirming Care

Covered when medically necessary.

YES

25.00%

100.00%
Generic Drugs

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$0.00

100.00%
Habilitation Services

Limit: 60.0 Visit(s) per Year

Visit limit applies to any combination of PT, OT, and ST. Limit does not apply for therapies to treat autism, mental health disorders, or substance-related and addictive disorders.

YES

$0.00

100.00%
Hearing Aids

Limit: 1.0 Item(s) per Year

Limited to one per hearing impaired ear per year.

YES

25.00%

100.00%
Home Health Care Services

Limit: 42.0 Visit(s) per Year

YES

25.00%

100.00%
Hospice Services
YES

25.00%

100.00%
Imaging (CT/PET Scans, MRIs)
YES

25.00%

100.00%
Infertility Treatment
NO
Infusion Therapy
YES

25.00%

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

25.00%

100.00%
Inpatient Physician and Surgical Services
YES

25.00%

100.00%
Laboratory Outpatient and Professional Services
YES

25.00%

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child

Benefit limitations may apply to individual services.

YES

25.00%

100.00%
Mental/Behavioral Health Inpatient Services
YES

25.00%

100.00%
Mental/Behavioral Health Outpatient Services

Cost share applies to office visits, please see SBC for Mental Health Outpatient Services.

YES

$0.00

100.00%
Non-Preferred Brand Drugs

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$50.00

100.00%
Nutritional Counseling

Medical or behavioral/mental health related nutritional education services that are provided as part of treatment for a disease are covered

YES

25.00%

100.00%
Orthodontia - Adult
NO
Orthodontia - Child

Coverage is for medically necessary orthodontia only.

YES

50.00%

100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

25.00%

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

25.00%

100.00%
Outpatient Rehabilitation Services

Limit: 60.0 Visit(s) per Year

Visit limit applies to any combination of PT, OT, and ST. Limit does not apply to pulmonary or cardiac rehabilitation therapy.

YES

$0.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

25.00%

100.00%
Preferred Brand Drugs

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$15.00

100.00%
Prenatal and Postnatal Care
YES

No Charge

100.00%
Preventive Care/Screening/Immunization
YES

0.00%

100.00%
Primary Care Visit to Treat an Injury or Illness

Cost sharing for Virtual Primary Care matches in-person office visit.

YES

$0.00

100.00%
Private-Duty Nursing

Private duty nursing is only available during inpatient stays and when determined to be medically necessary.

YES

25.00%

100.00%
Prosthetic Devices
YES

25.00%

100.00%
Radiation
YES

25.00%

100.00%
Reconstructive Surgery

Reconstructive procedures are covered when the primary purpose of the procedure is either treatment of a medical condition or required to improve or restore physiologic function.

YES

25.00%

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 60.0 Visit(s) per Year

Visit limit applies to any combination of PT, OT, and ST.

YES

$0.00

100.00%
Rehabilitative Speech Therapy

Limit: 60.0 Visit(s) per Year

Visit limit applies to any combination of PT, OT, and ST.

YES

$0.00

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

YES

No Charge

100.00%
Routine Foot Care

Covered as medically necessary for the prevention of complications associated with metabolic, neurologic, or peripheral vascular disease

NO
Skilled Nursing Facility

Limit: 90.0 Days per Year

Limit of 90 days will be any combination of Skilled Nursing Facility or Inpatient Rehabilitation Facility Services.

YES

25.00%

100.00%
Specialist Visit
YES

$10.00

100.00%
Specialty Drugs

Specialty medications are limited to a 1-month supply. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$150.00

100.00%
Substance Abuse Disorder Inpatient Services
YES

25.00%

100.00%
Substance Abuse Disorder Outpatient Services
YES

$0.00

100.00%
Transplant
YES

25.00%

100.00%
Treatment for Temporomandibular Joint Disorders
YES

25.00%

100.00%
Urgent Care Centers or Facilities
YES

$5.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

25.00%

100.00%

UHC Silver-C Standard $0 Indiv Ded ($0 PCP Visits, $0 Tier 2 Rx) Health Insurance Plan Variant 40702AZ0060018-06 Attributes

Plan Attribute Value
AV Calculator Output Number 0.9414114984395309
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type 94% AV Level Silver Plan
Dental Only Plan No
Design Type Design 1
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID AZF028
Formulary URL URL
HIOS Product ID 40702AZ006
Import Date 2024-08-16 01:01:20
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer ID 40702
Issuer Marketplace Marketing Name UnitedHealthcare
Market Coverage Individual
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 AZN011
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 plan also covers emergency health care services received outside the service area.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 40702AZ0060018-06
Plan Level Exclusions Some exclusions may apply. See the applicable Certificate of Coverage for details.
Plan Marketing Name UHC Silver Standard
Plan Type HMO
Plan Variant Marketing Name UHC Silver-C Standard $0 Indiv Ded ($0 PCP Visits, $0 Tier 2 Rx)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,000
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $70
SBC Scenario, Having Diabetes, Copayment $20
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $600
SBC Scenario, Treatment of a Simple Fracture, Copayment $10
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID AZS011
Source Name HIOS
Specialist Requiring a Referral All, except OBGYN and as state mandated.
Plan ID 40702AZ0060018
State Code AZ
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person 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 Group per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person 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 Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person 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 Per Group $4000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $2000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $2,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of UHC Silver Standard Health Insurance Plan, 40702AZ0060018

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about UHC Silver Standard, 40702AZ0060018 Health Insurance Plan, 40702AZ0060018

  • Does UHC Silver Standard Health Insurance Plan, 40702AZ0060018 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (40702AZ0060018) Health Insurance Plan, Variant (40702AZ0060018-06) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (40702AZ0060018) Health Insurance Plan, Variant (40702AZ0060018-06) have Out of Service Area Coverage?

    Yes. Details: Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The plan also covers emergency health care services received outside the service area.

 

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