SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358 - 83761GA0040358 Health Insurance Plan

Alliant Health Plans health insurance plan with the Plan ID 83761GA0040358. The plan is called SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 81.42% (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 18.58% 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 83761GA0040358
Health Insurance Plan Year 2022
State Georgia
Health Insurance Issuer Alliant Health Plans
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 83761GA0040358-00
Provider Network(s) ['GAN001']
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 Georgia 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 - 83761GA0040358-00

Standard On Exchange Plan - 83761GA0040358-01

Open to Indians below 300% FPL - 83761GA0040358-02

Open to Indians above 300% FPL - 83761GA0040358-03

Last Plan Update Date Wed, 10 Nov 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358-00 Health Insurance Plan Variant 83761GA0040358-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.814232566
Begin Primary Care Cost-Sharing After Number Of Visits 3
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Diabetes
EHB Percent of Total Premium 0.952018279
First Tier Utilization 100%
Formulary ID GAF006
Formulary URL URL
HIOS Product ID 83761GA004
Import Date 11/10/2021 0:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 83761
Issuer Marketplace Marketing Name Alliant Health Plans
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID GAN001
Out of Country Coverage No
Out of Country Coverage Description Coverage is available for emergency situations
Out of Service Area Coverage No
Out of Service Area Coverage Description In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AlliantPlans.com
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 83761GA0040358-00
Plan Marketing Name SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358
Plan Type PPO
Plan Variant Marketing Name SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358-00
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,500
SBC Scenario, Having a Baby, Copayment $30
SBC Scenario, Having a Baby, Deductible $1,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,000
SBC Scenario, Having Diabetes, Deductible $800
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $100
SBC Scenario, Treatment of a Simple Fracture, Copayment $100
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID GAS017
Source Name HIOS
Plan ID 83761GA0040358
State Code GA
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 $43000 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $21500 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $21,500
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 25.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $3000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,500
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $40000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $20000 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $20,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $13600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6800 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,800
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 SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358 Health Insurance Plan, 83761GA0040358

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

Frequently Asked Questions(FAQ) about SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358, 83761GA0040358 Health Insurance Plan, 83761GA0040358

  • Does SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358 Health Insurance Plan, 83761GA0040358 support Mail Ordering?

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

  • Does (83761GA0040358) Health Insurance Plan, Variant (83761GA0040358-00) offer Disease Management Programs?

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

    Does (83761GA0040358) Health Insurance Plan, Variant (83761GA0040358-00) have Out Of Country Coverage?

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

    Does (83761GA0040358) Health Insurance Plan, Variant (83761GA0040358-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan). Details: In-Network providers available in certain Tennessee counties that border Georgia. Verify participating providers at AlliantPlans.com

    Does (83761GA0040358) Health Insurance Plan, Variant (83761GA0040358-00) offer Disease Management Programs?

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

    Does SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358-00 Health Insurance Plan, Variant (83761GA0040358-00) offer Disease Management Programs for Asthma?

    Yes, the SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358-00 Health Insurance Plan Variant 83761GA0040358-00 offers Disease Management Program for Asthma.

    Does SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358-00 Health Insurance Plan, Variant (83761GA0040358-00) offer Disease Management Programs for Diabetes?

    Yes, the SoloCare Gold PPO (3 Free PCP Visits + Chiro + Dental) 40358-00 Health Insurance Plan Variant 83761GA0040358-00 offers Disease Management Program for Diabetes.

 

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