Value Bronze Standard POS HSA - 94815CT0050008 Health Insurance Plan

ConnectiCare Insurance Company Inc. health insurance plan with the Plan ID 94815CT0050008. The plan is called Value Bronze Standard POS HSA.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.94% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.06% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 94815CT0050008
Health Insurance Plan Year 2024
State Connecticut
Health Insurance Issuer ConnectiCare Insurance Company Inc.
Health Insurance Plan Variant 94815CT0050008-01
Provider Network(s) ['CTN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Connecticut All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard On Exchange Plan - 94815CT0050008-01

Open to Indians below 300% FPL - 94815CT0050008-02

Open to Indians above 300% FPL - 94815CT0050008-03

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Value Bronze Standard POS HSA Health Insurance Plan Variant 94815CT0050008-01 Attributes

Plan Attribute Value
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Diabetes, Heart Disease, Asthma
EHB Percent of Total Premium 99%
First Tier Utilization 100%
Formulary ID CTF003
HIOS Product ID 94815CT005
Import Date 2/12/2024
HSA Eligible Yes
IsItANewPlan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 64.94%
Issuer ID 94815
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID CTN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 94815CT0050008-01
Plan Marketing Name Value Bronze Standard POS HSA
Plan Type POS
Plan Variant Marketing Name Value Bronze Standard POS HSA
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $700
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $6,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $300
SBC Scenario, Having Diabetes, Deductible $2,300
SBC Scenario, Having Diabetes, Limit $20
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 CTS001
Source Name SERFF
Specialty Drug Maximum Coinsurance $500
Plan ID 94815CT0050008
State Code CT
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 20.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family $6500 per person | $13000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,500
TEHBDedOutofNetFamily $13000 per person | $26000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Individual $13,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $7225 per person | $14450 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,225
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $14450 per person | $28900 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $14,450
Unique Plan Design Yes
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of Value Bronze Standard POS HSA Health Insurance Plan, 94815CT0050008

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

Frequently Asked Questions(FAQ) about Value Bronze Standard POS HSA, 94815CT0050008 Health Insurance Plan, 94815CT0050008

  • Does Value Bronze Standard POS HSA Health Insurance Plan, 94815CT0050008 support Mail Ordering?

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

  • Does (94815CT0050008) Health Insurance Plan, Variant (94815CT0050008-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes, Heart Disease, Asthma

    Does (94815CT0050008) Health Insurance Plan, Variant (94815CT0050008-01) have Out Of Country Coverage?

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

    Does (94815CT0050008) Health Insurance Plan, Variant (94815CT0050008-01) have Out of Service Area Coverage?

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

    Does (94815CT0050008) Health Insurance Plan, Variant (94815CT0050008-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes, Heart Disease, Asthma

    Does Value Bronze Standard POS HSA Health Insurance Plan, Variant (94815CT0050008-01) offer Disease Management Programs for Asthma?

    Yes, the Value Bronze Standard POS HSA Health Insurance Plan Variant 94815CT0050008-01 offers Disease Management Program for Asthma.

    Does Value Bronze Standard POS HSA Health Insurance Plan, Variant (94815CT0050008-01) offer Disease Management Programs for Heart disease?

    Yes, the Value Bronze Standard POS HSA Health Insurance Plan Variant 94815CT0050008-01 offers Disease Management Program for Heart disease.

    Does Value Bronze Standard POS HSA Health Insurance Plan, Variant (94815CT0050008-01) offer Disease Management Programs for Diabetes?

    Yes, the Value Bronze Standard POS HSA Health Insurance Plan Variant 94815CT0050008-01 offers Disease Management Program for Diabetes.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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