SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013 - 83761GA0110013 Health Insurance Plan

Alliant Health Plans health insurance plan with the Plan ID 83761GA0110013. The plan is called SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.98% (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 35.02% 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 83761GA0110013
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 83761GA0110013-00
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 - 83761GA0110013-00

Standard On Exchange Plan - 83761GA0110013-01

Open to Indians below 300% FPL - 83761GA0110013-02

Open to Indians above 300% FPL - 83761GA0110013-03

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

SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013-00 Health Insurance Plan Variant 83761GA0110013-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.649755878
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 Bronze Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Diabetes
EHB Percent of Total Premium 0.961168781
First Tier Utilization 100%
Formulary ID GAF010
Formulary URL URL
HIOS Product ID 83761GA011
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 Expanded Bronze
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) 83761GA0110013-00
Plan Marketing Name SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013
Plan Type HMO
Plan Variant Marketing Name SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013-00
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $8,700
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $2,500
SBC Scenario, Having Diabetes, Deductible $1,600
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $10
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,400
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID GAS017
Source Name HIOS
Plan ID 83761GA0110013
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 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 $17400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $8700 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $8,700
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 $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
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 Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013 Health Insurance Plan, 83761GA0110013

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

Frequently Asked Questions(FAQ) about SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013, 83761GA0110013 Health Insurance Plan, 83761GA0110013

  • Does SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013 Health Insurance Plan, 83761GA0110013 support Mail Ordering?

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

  • Does (83761GA0110013) Health Insurance Plan, Variant (83761GA0110013-00) offer Disease Management Programs?

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

    Does (83761GA0110013) Health Insurance Plan, Variant (83761GA0110013-00) 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 (83761GA0110013) Health Insurance Plan, Variant (83761GA0110013-00) 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 (83761GA0110013) Health Insurance Plan, Variant (83761GA0110013-00) offer Disease Management Programs?

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

    Does SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013-00 Health Insurance Plan, Variant (83761GA0110013-00) offer Disease Management Programs for Asthma?

    Yes, the SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013-00 Health Insurance Plan Variant 83761GA0110013-00 offers Disease Management Program for Asthma.

    Does SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013-00 Health Insurance Plan, Variant (83761GA0110013-00) offer Disease Management Programs for Diabetes?

    Yes, the SoloCare Bronze No Referral HMO ($250 Specialty Drug Copay + Dental) 110013-00 Health Insurance Plan Variant 83761GA0110013-00 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