UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO - 16322PA0040026 Health Insurance Plan
UPMC HEALTH OPTIONS INC. health insurance plan with the Plan ID 16322PA0040026. The plan is called UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO.
| Health Insurance Plan ID | 16322PA0040026 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Pennsylvania | ||||||||||||||||||
| Health Insurance Issuer | UPMC HEALTH OPTIONS INC. | ||||||||||||||||||
| Health Insurance Plan Variant | 16322PA0040026-01 | ||||||||||||||||||
| Provider Network(s) | ['PAN008'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 26 Nov 2024 06:27 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 | Tue, 26 Nov 2024 06:27 GMT |
UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant 16322PA0040026-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Catastrophic On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| EHB Percent of Total Premium | 100% |
| First Tier Utilization | 100% |
| Formulary ID | PAF001 |
| HIOS Product ID | 16322PA004 |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 16322 |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Catastrophic |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | PAN008 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Dental Services and Emergency Medical Services Only |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 16322PA0040026-01 |
| Plan Marketing Name | UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO |
| Plan Type | PPO |
| Plan Variant Marketing Name | UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,450 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,400 |
| SBC Scenario, Having Diabetes, Limit | $40 |
| 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 | PAS007 |
| Source Name | SERFF |
| Plan ID | 16322PA0040026 |
| State Code | PA |
| 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 | $9450 per person | $18900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,450 |
| TEHBDedOutofNetFamily | $15000 per person | $30000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $15,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $9450 per person | $18900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,450 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | $15000 per person | $30000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $15,000 |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | Yes |
Copay & Coinsurance of UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, 16322PA0040026
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO, 16322PA0040026 Health Insurance Plan, 16322PA0040026
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Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, 16322PA0040026 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (16322PA0040026) Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does (16322PA0040026) Health Insurance Plan, Variant (16322PA0040026-01) have Out Of Country Coverage?
Yes. Details: Emergency Services Only
Does (16322PA0040026) Health Insurance Plan, Variant (16322PA0040026-01) have Out of Service Area Coverage?
Yes. Details: Dental Services and Emergency Medical Services Only
Does (16322PA0040026) Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, High Blood Pressure & High Cholesterol, Weight Loss Programs, Pain Management, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for Asthma?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for Asthma.
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for Heart disease?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for Heart disease.
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for Depression?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for Depression.
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for Diabetes?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for Diabetes.
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for Low back pain?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for Low back pain.
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for Pregnancy?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for Pregnancy.
Does UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan, Variant (16322PA0040026-01) offer Disease Management Programs for Weight loss programs?
Yes, the UPMC Advantage + Premium Network + Catastrophic $9,450 + PPO Health Insurance Plan Variant
16322PA0040026-01 offers Disease
Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Tue, 26 Nov 2024 06:27 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