Voyager Silver 4500 - 60597ID0380001 Health Insurance Plan

PacificSource Health Plans health insurance plan with the Plan ID 60597ID0380001. The plan is called Voyager Silver 4500.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.80% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.20% of the costs of all covered benefits (according to the Issuer).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.84% (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 28.16% 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 60597ID0380001
Health Insurance Plan Year 2024
State Idaho
Health Insurance Issuer PacificSource Health Plans
Health Insurance Plan Variant 60597ID0380001-01
Provider Network(s) ['IDN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 GMT).

Providers Idaho 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 - 60597ID0380001-01

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 17 Dec 2024 06:12 GMT

Voyager Silver 4500 Health Insurance Plan Variant 60597ID0380001-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.718389509
Business Year 2024
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered Yes
CSR Variation Type Standard Silver On Exchange Plan
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 35.00%
Drug EHB Deductible, In Network (Tier 1), Family $0 per person | $0 per group
Drug EHB Deductible, In Network (Tier 1), Individual $0
Drug EHB Deductible, Out of Network, Family $10000 per person | $20000 per group
Drug EHB Deductible, Out of Network, Individual $10,000
Dental Only Plan No
First Tier Utilization 100%
Formulary ID IDF009
HIOS Product ID 60597ID038
HSA/HRA Employer Contribution No
Import Date 2/12/2024
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 71.80%
Issuer ID 60597
Market Coverage SHOP (Small Group)
Medical Drug Deductibles Integrated No
Medical Drug Maximum Out of Pocket Integrated Yes
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 35.00%
Medical EHB Deductible, In Network (Tier 1), Family $4500 per person | $9000 per group
Medical EHB Deductible, In Network (Tier 1), Individual $4,500
Medical EHB Deductible, Out of Network, Family $10000 per person | $20000 per group
Medical EHB Deductible, Out of Network, Individual $10,000
Metal Level Silver
Multiple In Network Tiers No
National Network Yes
Network ID IDN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Care Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Out-of-network providers
Plan Effective Date 1/1/2024
Plan ID (Standard Component ID with Variant) 60597ID0380001-01
Plan Marketing Name Voyager Silver 4500
Plan Type PPO
Plan Variant Marketing Name Voyager Silver 4500
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,400
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $4,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,500
SBC Scenario, Having Diabetes, Deductible $900
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $400
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID IDS001
Source Name SERFF
Plan ID 60597ID0380001
State Code ID
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
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $9100 per person | $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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 Yes
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of Voyager Silver 4500 Health Insurance Plan, 60597ID0380001

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

Frequently Asked Questions(FAQ) about Voyager Silver 4500, 60597ID0380001 Health Insurance Plan, 60597ID0380001

  • Does Voyager Silver 4500 Health Insurance Plan, 60597ID0380001 support Mail Ordering?

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

  • Does (60597ID0380001) Health Insurance Plan, Variant (60597ID0380001-01) have Out Of Country Coverage?

    Yes. Details: Emergency Care Only

    Does (60597ID0380001) Health Insurance Plan, Variant (60597ID0380001-01) have Out of Service Area Coverage?

    Yes. Details: Out-of-network providers

 

Disclaimer: This is based on the import(Date: Tue, 17 Dec 2024 06:12 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