UHC Silver Value Plan - 72375MD0070032 Health Insurance Plan
Optimum Choice, Inc. health insurance plan with the Plan ID 72375MD0070032. The plan is called UHC Silver Value Plan.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 87.48% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 12.52% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 72375MD0070032 | ||||||||||||||||||
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| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Maryland | ||||||||||||||||||
| Health Insurance Issuer | Optimum Choice, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 72375MD0070032-05 | ||||||||||||||||||
| Provider Network(s) | ['MDN003'] | ||||||||||||||||||
| 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 - 72375MD0070032-01 Open to Indians below 300% FPL - 72375MD0070032-02 Open to Indians above 300% FPL - 72375MD0070032-03 73% AV Silver Plan - 72375MD0070032-04 |
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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 Silver-D Value Plan Health Insurance Plan Variant 72375MD0070032-05 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 87% AV Level Silver Plan |
| Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Individual | Not Applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $150 per person | $300 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $150 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual | $500 |
| Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Individual | $500 per person | $1000 per group |
| Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 99% |
| First Tier Utilization | 100% |
| Formulary ID | MDF007 |
| HIOS Product ID | 72375MD007 |
| Import Date | 5/31/2024 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 87.48% |
| Issuer ID | 72375 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | No |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | Not Applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $1000 per person | $2000 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $1,000 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family | $2500 per person | $5000 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $2,500 |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual | Not Applicable |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MDN003 |
| 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) | 72375MD0070032-05 |
| Plan Level Exclusions | 0 |
| Plan Marketing Name | UHC Silver Value Plan |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC Silver-D Value Plan |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $600 |
| SBC Scenario, Having a Baby, Deductible | $1,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $200 |
| SBC Scenario, Having Diabetes, Deductible | $1,000 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,000 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MDS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All, except OBGYN and as state mandated |
| Plan ID | 72375MD0070032 |
| State Code | MD |
| Unique Plan Design | Yes |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of UHC Silver Value Plan Health Insurance Plan, 72375MD0070032
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about UHC Silver Value Plan, 72375MD0070032 Health Insurance Plan, 72375MD0070032
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Does UHC Silver Value Plan Health Insurance Plan, 72375MD0070032 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (72375MD0070032) Health Insurance Plan, Variant (72375MD0070032-05) have Out Of Country Coverage?
Does (72375MD0070032) Health Insurance Plan, Variant (72375MD0070032-05) 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