WA Individual Premier PPO - 75928WA0030001 Health Insurance Plan
75928 health insurance plan with the Plan ID 75928WA0030001. The plan is called WA Individual Premier PPO.
| Health Insurance Plan ID | 75928WA0030001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Washington | ||||||||||||||||||
| Health Insurance Issuer | 75928 | ||||||||||||||||||
| Health Insurance Plan Variant | 75928WA0030001-01 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 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, 17 Dec 2024 06:12 GMT |
WA Individual Premier PPO Health Insurance Plan Variant 75928WA0030001-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard High On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 100.00% |
| First Tier Utilization | 100% |
| HIOS Product ID | 75928WA003 |
| Import Date | 2/12/2024 |
| Guaranteed Rate | Guaranteed Rate |
| IsItANewPlan | New |
| Issuer ID | 75928 |
| Market Coverage | Individual |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family | $375 per person | $750 per group |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $375 |
| Medical EHB Deductible, Combined In/Out of Network, Family | $85 per person | $255 per group |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $85 |
| Medical EHB Deductible, In Network (Tier 1), Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
| 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 | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | Not Applicable |
| 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 | High |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | WAN001 |
| Out of Country Coverage | No |
| Out of Country Coverage Description | Care, supplies, or services received outside of the United States or from a non-U.S. Provider are not covered. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | PPO network or out-of-network coverage at PPO fee |
| Plan Effective Date | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 75928WA0030001-01 |
| Plan Marketing Name | WA Individual Premier PPO |
| Plan Type | PPO |
| Plan Variant Marketing Name | WA Individual Premier PPO |
| QHP/Non QHP | On the Exchange |
| Service Area ID | WAS001 |
| Source Name | SERFF |
| Plan ID | 75928WA0030001 |
| State Code | WA |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of WA Individual Premier PPO Health Insurance Plan, 75928WA0030001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about WA Individual Premier PPO, 75928WA0030001 Health Insurance Plan, 75928WA0030001
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Does WA Individual Premier PPO Health Insurance Plan, 75928WA0030001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (75928WA0030001) Health Insurance Plan, Variant (75928WA0030001-01) have Out Of Country Coverage?
Does (75928WA0030001) Health Insurance Plan, Variant (75928WA0030001-01) have Out of Service Area Coverage?
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