2023 HMO 9100 Elite Catastrophic - 20129IL0330020 Health Insurance Plan

Health Alliance Medical Plans, Inc. health insurance plan with the Plan ID 20129IL0330020. The plan is called 2023 HMO 9100 Elite Catastrophic.

Health Insurance Plan ID 20129IL0330020
Health Insurance Plan Year 2023
State Illinois
Health Insurance Issuer Health Alliance Medical Plans, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 20129IL0330020-00
Provider Network(s) ['ILN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Illinois 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 Off Exchange Plan - 20129IL0330020-00

Standard On Exchange Plan - 20129IL0330020-01

Last Plan Update Date Fri, 21 Oct 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, 20129IL0330020-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
YES

No Charge after deductible

100.00%
Accidental Dental
YES

No Charge after deductible

100.00%
Acupuncture

Limit: 15.0 Visit(s) per Year

YES

No Charge after deductible

100.00%
Allergy Testing
YES

No Charge after deductible

100.00%
Bariatric Surgery
YES

No Charge after deductible

100.00%
Basic Dental Care - Adult
NO
Basic Dental Care - Child
YES

No Charge after deductible

100.00%
Chemotherapy
YES

No Charge after deductible

100.00%
Chiropractic Care

Limit: 25.0 Visit(s) per Year

Spinal Manipulations Only

YES

No Charge after deductible

100.00%
Cosmetic Surgery

Cosmetic surgery for the correction of the congenital deformities or for conditions resulting from accidental injuries, scars, tumors or disease is covered.

YES

No Charge after deductible

100.00%
Delivery and All Inpatient Services for Maternity Care
YES

No Charge after deductible

100.00%
Dental Check-Up for Children

Limit: 1.0 Exam(s) per 6 Months

YES

No Charge

100.00%
Diabetes Education

Services must be rendered by a physician, or duly certified, or licensed health care professional with expertise in diabetes management.

YES

No Charge after deductible

100.00%
Dialysis
YES

No Charge after deductible

100.00%
Durable Medical Equipment
YES

No Charge after deductible

100.00%
Emergency Room Services
YES

No Charge after deductible

No Charge after deductible
Emergency Transportation/Ambulance
YES

No Charge after deductible

No Charge after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

No Charge

100.00%
Gender Affirming Care
YES

No Charge after deductible

100.00%
Generic Drugs

All covered preventive drugs will be at $0 cost share

YES

No Charge after deductible

100.00%
Habilitation Services

Limit: 60.0 Visit(s) per Year

Treatment must be medically necessary and therapeutic and not investigational.

YES

No Charge after deductible

100.00%
Hearing Aids

Limit: 2.0 Item(s) per 2 Years

One hearing instrument per ear every 24 months for members, with no dollar limit for children under the age of 18. Members over the age of 18 will be subject to a $2500/instrument limit.

YES

No Charge after deductible

100.00%
Home Health Care Services
YES

No Charge after deductible

100.00%
Hospice Services
YES

No Charge after deductible

100.00%
Imaging (CT/PET Scans, MRIs)

Benefit provided for outpatient services and when these services are related to surgery or medical care.

YES

No Charge after deductible

100.00%
Infertility Treatment

Limit: 6.0 Procedure(s) per Year

4 Completed oocyte retrievals per plan year, if a live birth, two additional completed Oocyte Retreivals

YES

No Charge after deductible

100.00%
Infusion Therapy
YES

No Charge after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

No Charge after deductible

100.00%
Inpatient Physician and Surgical Services
YES

No Charge after deductible

100.00%
Laboratory Outpatient and Professional Services

Benefit provided for outpatient services and when these services are related to surgery or medical care.

YES

No Charge after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child

Limitations vary based on procedures.

YES

No Charge after deductible

100.00%
Mental/Behavioral Health Inpatient Services
YES

No Charge after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

No Charge after deductible

100.00%
Non-Preferred Brand Drugs
YES

No Charge after deductible

100.00%
Nutritional Counseling
YES

No Charge after deductible

100.00%
Orthodontia - Adult
NO
Orthodontia - Child

Limitations vary based on procedures.

YES

No Charge after deductible

100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

No Charge after deductible

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

No Charge after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 60.0 Visit(s) per Year

Combined PT/OT/ST all considered outpatient rehabilitation 60 visits per condition per year Maintenance therapies not covered.

YES

No Charge after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

No Charge after deductible

100.00%
Preferred Brand Drugs
YES

No Charge after deductible

100.00%
Prenatal and Postnatal Care

Benefits will be available for that care from the moment of birth up to the first 31 days, thereafter, you must add the newborn child to your Family Coverage.

YES

No Charge after deductible

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

No Charge after deductible

100.00%
Private-Duty Nursing
YES

No Charge after deductible

100.00%
Prosthetic Devices

Covered under Durable Medical Equipment benefit

YES

No Charge after deductible

100.00%
Radiation
YES

No Charge after deductible

100.00%
Reconstructive Surgery

Only includes benefits for mastectomy-related services.

YES

No Charge after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 60.0 Visit(s) per Year

Combined PT/OT/ST all considered outpatient rehabilitation 60 visits per condition per year. Maintenance Speech Therapy is not covered.

YES

No Charge after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 60.0 Visit(s) per Year

Combined PT/OT/ST all considered outpatient rehabilitation 60 visits per condition per year. When rendered for the treatment of psychosocial speech delay, behavioral problems (including impulsive behavior and impulsivity syndrome) attention disorder, conceptual handicap or mental retardation, except as may be provided under this Certificate for Autism Spectrum Disorder(s).

YES

No Charge after deductible

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)

Limit: 1.0 Exam(s) per Year

YES

No Charge after deductible

100.00%
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Year

YES

No Charge

100.00%
Routine Foot Care

Only covered for persons diagnosed with diabetes.

YES

No Charge after deductible

100.00%
Skilled Nursing Facility
YES

No Charge after deductible

100.00%
Specialist Visit
YES

No Charge after deductible

100.00%
Specialty Drugs
YES

No Charge after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

No Charge after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

No Charge after deductible

100.00%
Transplant
YES

No Charge after deductible

100.00%
Treatment for Temporomandibular Joint Disorders
YES

No Charge after deductible

100.00%
Urgent Care Centers or Facilities
YES

No Charge after deductible

No Charge after deductible
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging

Benefit provided for outpatient services and when these services are related to surgery or medical care.

YES

No Charge after deductible

100.00%

2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits 2
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Catastrophic Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 0.996
First Tier Utilization 100%
Formulary ID ILF008
Formulary URL URL
HIOS Product ID 20129IL033
Import Date 10/21/2022 20:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer ID 20129
Issuer Marketplace Marketing Name Health Alliance
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 ILN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Coverage Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Coverage Only
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 20129IL0330020-00
Plan Level Exclusions Custodial Care, Weight Lost Programs
Plan Marketing Name 2023 HMO 9100 Elite Catastrophic
Plan Type HMO
Plan Variant Marketing Name 2023 HMO 9100 Elite Catastrophic
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $9,100
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $500
SBC Scenario, Having Diabetes, Deductible $2,100
SBC Scenario, Having Diabetes, Limit $0
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 ILS001
Source Name SERFF
Specialist Requiring a Referral Specialists (IN) will require a referral except OB-GYN and Optometrists
Plan ID 20129IL0330020
State Code IL
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person 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 Group per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person 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 Per Group $18200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $9100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,100
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
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 Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, 20129IL0330020

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

Frequently Asked Questions(FAQ) about 2023 HMO 9100 Elite Catastrophic, 20129IL0330020 Health Insurance Plan, 20129IL0330020

  • Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, 20129IL0330020 support Mail Ordering?

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

  • Does (20129IL0330020) Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does (20129IL0330020) Health Insurance Plan, Variant (20129IL0330020-00) have Out Of Country Coverage?

    Yes. Details: Emergency Coverage Only

    Does (20129IL0330020) Health Insurance Plan, Variant (20129IL0330020-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Coverage Only

    Does (20129IL0330020) Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for Asthma?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for Asthma.

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for Heart disease?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for Heart disease.

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for Depression?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for Depression.

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for Diabetes?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for Diabetes.

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for Low back pain?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for Low back pain.

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for Pregnancy?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for Pregnancy.

    Does 2023 HMO 9100 Elite Catastrophic Health Insurance Plan, Variant (20129IL0330020-00) offer Disease Management Programs for Weight loss programs?

    Yes, the 2023 HMO 9100 Elite Catastrophic Health Insurance Plan Variant 20129IL0330020-00 offers Disease Management Program for Weight loss programs.

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 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