| Field | Data |
|---|---|
| Health Insurance Plan ID | 20129IL0340077 |
| 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 |
| Last Plan Update Date | Fri, 21 Oct 2022 00:00 GMT |
| Last Import Date | Sun, 24 Sep 2023 09:34 GMT |
| Health Insurance Plan Variant | 20129IL0340077-03 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.638469039 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | Yes |
| CSR Variation Type | Limited Cost Sharing Plan Variation |
| 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 | ILF007 |
| Formulary URL | URL |
| HIOS Product ID | 20129IL034 |
| 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 | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ILN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Out of Network Coverage Available |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of Network Coverage Available |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 20129IL0340077-03 |
| Plan Level Exclusions | Custodial Care, Weight Lost Programs |
| Plan Marketing Name | 2023 POS 8000 Elite Bronze |
| Plan Type | POS |
| Plan Variant Marketing Name | 2023 POS 8000 Elite Bronze |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $500 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,500 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $1,300 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ILS001 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Specialists (IN) may require a referral except OB-GYN and Optometrists |
| Plan ID | 20129IL0340077 |
| State Code | IL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $74000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $37000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $37,000 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $48000 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $24000 per person |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $24,000 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $16000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $8000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,000 |
| TEHBDedOutOfNetFamilyPerGroup | $32000 per group |
| TEHBDedOutOfNetFamilyPerPerson | $16000 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $16,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $17000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,500 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $57000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $28500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $28,500 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about 2023 POS 8000 Elite Bronze, 20129IL0340077 Health Insurance Plan, 20129IL0340077
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, 20129IL0340077 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (20129IL0340077) Health Insurance Plan, Variant (20129IL0340077-03) 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 (20129IL0340077) Health Insurance Plan, Variant (20129IL0340077-03) have Out Of Country Coverage?
Yes. Details: Out of Network Coverage Available
Does (20129IL0340077) Health Insurance Plan, Variant (20129IL0340077-03) have Out of Service Area Coverage?
Yes. Details: Out of Network Coverage Available
Does (20129IL0340077) Health Insurance Plan, Variant (20129IL0340077-03) 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 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Asthma?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Asthma.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Heart disease?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Heart disease.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Depression?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Depression.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Diabetes?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Diabetes.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for High blood pressure & high cholesterol.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Low back pain?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Low back pain.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Pain management?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Pain management.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Pregnancy?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Pregnancy.
Does 2023 POS 8000 Elite Bronze Health Insurance Plan, Variant (20129IL0340077-03) offer Disease Management Programs for Weight loss programs?
Yes, the 2023 POS 8000 Elite Bronze Health Insurance Plan Variant 20129IL0340077-03 offers Disease Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Sun, 24 Sep 2023 09:34 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