UnitedHealthcare Insurance Company health insurance plan with the Plan ID 69461AL0110004. The plan is called UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, No Referrals).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 73.01% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 26.99% of the costs of all covered benefits (according to the Issuer).
Health Insurance Plan ID | 69461AL0110004 | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Alabama | ||||||||||||||||||
Health Insurance Issuer | UnitedHealthcare Insurance Company | ||||||||||||||||||
Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 69461AL0110004-04 | ||||||||||||||||||
Provider Network(s) | NETWORK NON-PREFERRED | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 27 Aug 2024 05:58 GMT). |
|
||||||||||||||||||
Available Variants of the Health Plan | Standard Off Exchange Plan - 69461AL0110004-00 Standard On Exchange Plan - 69461AL0110004-01 Open to Indians below 300% FPL - 69461AL0110004-02 Open to Indians above 300% FPL - 69461AL0110004-03 73% AV Silver Plan - 69461AL0110004-04 |
||||||||||||||||||
Last Plan Update Date | Sat, 02 Dec 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 27 Aug 2024 05:58 GMT |
Benefit | Covered | In Network | Out Of Network |
---|---|---|---|
Abortion for Which Public Funding is Prohibited
|
NO | ||
Accidental Dental
|
YES | 40% Coinsurance after deductible |
100.00% |
Acupuncture
|
NO | ||
Allergy Testing
|
YES | $80.00 |
100.00% |
Bariatric Surgery
|
NO | ||
Basic Dental Care - Adult
|
NO | ||
Basic Dental Care - Child
Benefit limitations may apply to individual services. |
YES | 40% Coinsurance after deductible |
100.00% |
Chemotherapy
|
YES | 40% Coinsurance after deductible |
100.00% |
Chiropractic Care
Limit: 10.0 Visit(s) per Year |
YES | 40% Coinsurance after deductible |
100.00% |
Cosmetic Surgery
|
NO | ||
Delivery and All Inpatient Services for Maternity Care
Childbirth/delivery professional services follow inpatient physician/surgeon fees. |
YES | 40% Coinsurance after deductible |
100.00% |
Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months |
YES | No Charge |
100.00% |
Diabetes Education
|
YES | 40% Coinsurance after deductible |
100.00% |
Dialysis
|
YES | 40% Coinsurance after deductible |
100.00% |
Durable Medical Equipment
|
YES | 40% Coinsurance after deductible |
100.00% |
Emergency Room Services
|
YES | 40% Coinsurance after deductible |
40% Coinsurance after deductible |
Emergency Transportation/Ambulance
|
YES | 40% Coinsurance after deductible |
40% Coinsurance after deductible |
Eye Glasses for Children
Limit: 1.0 Item(s) per Year |
YES | 40% Coinsurance after deductible |
100.00% |
Gender Affirming Care
|
NO | ||
Generic Drugs
Limit: 30.0 Days per Month |
YES | $3.00 |
100.00% |
Habilitation Services
Limit: 30.0 Visit(s) per Year 30 visits for any combination of physical therapy, occupational therapy and speech therapy |
YES | 40% Coinsurance after deductible |
100.00% |
Hearing Aids
|
NO | ||
Home Health Care Services
Limit: 60.0 Visit(s) per Year |
YES | 40% Coinsurance after deductible |
100.00% |
Hospice Services
|
YES | 40% Coinsurance after deductible |
100.00% |
Imaging (CT/PET Scans, MRIs)
|
YES | 40% Coinsurance after deductible |
100.00% |
Infertility Treatment
|
NO | ||
Infusion Therapy
|
YES | 40% Coinsurance after deductible |
100.00% |
Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | 40% Coinsurance after deductible |
100.00% |
Inpatient Physician and Surgical Services
|
YES | 40% Coinsurance after deductible |
100.00% |
Laboratory Outpatient and Professional Services
|
YES | $20.00 |
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 | 40% Coinsurance after deductible |
100.00% |
Mental/Behavioral Health Inpatient Services
|
YES | 40% Coinsurance after deductible |
100.00% |
Mental/Behavioral Health Outpatient Services
|
YES | $80.00 |
100.00% |
Non-Preferred Brand Drugs
Limit: 30.0 Days per Month |
YES | 40% Coinsurance after deductible |
100.00% |
Nutritional Counseling
|
NO | ||
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
Coverage is for medically necessary orthodontia only. |
YES | 50% Coinsurance after deductible |
100.00% |
Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | 40% Coinsurance after deductible |
100.00% |
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | 40% Coinsurance after deductible |
100.00% |
Outpatient Rehabilitation Services
Limit: 30.0 Visit(s) per Year 30 visits for any combination of physical therapy, occupational therapy and speech therapy. |
YES | 40% Coinsurance after deductible |
100.00% |
Outpatient Surgery Physician/Surgical Services
|
YES | 40% Coinsurance after deductible |
100.00% |
Preferred Brand Drugs
Limit: 30.0 Days per Month |
YES | $55 Copay after deductible |
100.00% |
Prenatal and Postnatal Care
|
YES | No Charge |
100.00% |
Preventive Care/Screening/Immunization
|
YES | No Charge |
100.00% |
Primary Care Visit to Treat an Injury or Illness
Cost sharing for Virtual Primary Care matches in-person office visit. See SBC for additional cost share details. |
YES | $5.00 |
100.00% |
Private-Duty Nursing
|
NO | ||
Prosthetic Devices
|
YES | 40% Coinsurance after deductible |
100.00% |
Radiation
|
YES | 40% Coinsurance after deductible |
100.00% |
Reconstructive Surgery
|
YES | 40% Coinsurance after deductible |
100.00% |
Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 30.0 Visit(s) per Year 30 visits for any combination of physical therapy, occupational therapy and speech therapy. |
YES | 40% Coinsurance after deductible |
100.00% |
Rehabilitative Speech Therapy
Limit: 30.0 Visit(s) per Year 30 visits for any combination of physical therapy, occupational therapy and speech therapy. |
YES | 40% Coinsurance after deductible |
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
|
NO | ||
Skilled Nursing Facility
Limit: 60.0 Days per Year Limit will be any combination of Skilled Nursing Facility or Inpatient Rehabilitation Facility Services. |
YES | 40% Coinsurance after deductible |
100.00% |
Specialist Visit
|
YES | $80.00 |
100.00% |
Specialty Drugs
Limit: 30.0 Days per Month Covers outpatient self-administered prescription legend drugs from a participating network pharmacy. Quantity limits per prescription may apply. |
YES | 50% Coinsurance after deductible |
100.00% |
Substance Abuse Disorder Inpatient Services
|
YES | 40% Coinsurance after deductible |
100.00% |
Substance Abuse Disorder Outpatient Services
|
YES | $80.00 |
100.00% |
Transplant
|
YES | 40% Coinsurance after deductible |
100.00% |
Treatment for Temporomandibular Joint Disorders
|
NO | ||
Urgent Care Centers or Facilities
$0 Virtual Urgent Care visits. See SBC for additional cost share details. |
YES | $75.00 |
100.00% |
Weight Loss Programs
|
NO | ||
Well Baby Visits and Care
|
YES | No Charge |
100.00% |
X-rays and Diagnostic Imaging
|
YES | 40% Coinsurance after deductible |
100.00% |
Plan Attribute | Value |
---|---|
Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
Business Year | 2024 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | 73% AV Level Silver Plan |
Dental Only Plan | No |
Design Type | Not Applicable |
EHB Percent of Total Premium | 1.0 |
First Tier Utilization | 100% |
Formulary ID | ALF006 |
Formulary URL | URL |
HIOS Product ID | 69461AL011 |
Import Date | 2023-12-02 01:01:42 |
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? | No |
Issuer Actuarial Value | 73.01% |
Issuer ID | 69461 |
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 | ALN001 |
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 Brochure | URL |
Plan Effective Date | 2024-01-01 |
Plan ID (Standard Component ID with Variant) | 69461AL0110004-04 |
Plan Marketing Name | UHC Silver Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, No Referrals) |
Plan Type | EPO |
Plan Variant Marketing Name | UHC Silver-E Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, $0 Insulin, No Referrals) |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $2,600 |
SBC Scenario, Having a Baby, Copayment | $200 |
SBC Scenario, Having a Baby, Deductible | $3,500 |
SBC Scenario, Having a Baby, Limit | $60 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $300 |
SBC Scenario, Having Diabetes, Deductible | $3,500 |
SBC Scenario, Having Diabetes, Limit | $0 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $100 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Service Area ID | ALS001 |
Source Name | HIOS |
Plan ID | 69461AL0110004 |
State Code | AL |
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 | 40.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $7000 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $3500 per person |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,500 |
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 | $15000 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7500 per person |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,500 |
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 | Yes |
URL for Enrollment Payment | URL |
URL for Summary of Benefits & Coverage | URL |
Wellness Program Offered | No |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
---|
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Disclaimer: This is based on the import(Date: Tue, 27 Aug 2024 05:58 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