Ambetter Balanced Care 26 (QualChoice) - 70525AR0070286 Health Insurance Plan

QCA Health Plan, Inc. health insurance plan with the Plan ID 70525AR0070286. The plan is called Ambetter Balanced Care 26 (QualChoice).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.26% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.74% of the costs of all covered benefits (according to the Issuer).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.51% (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 29.49% 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 70525AR0070286
Health Insurance Plan Year 2022
State Arkansas
Health Insurance Issuer QCA Health Plan, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 70525AR0070286-00
Provider Network(s) ['ARN001']
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 Arkansas 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 - 70525AR0070286-00

Standard On Exchange Plan - 70525AR0070286-01

Open to Indians below 300% FPL - 70525AR0070286-02

Open to Indians above 300% FPL - 70525AR0070286-03

73% AV Silver Plan - 70525AR0070286-04

87% AV Silver Plan - 70525AR0070286-05

94% AV Silver Plan - 70525AR0070286-06

Last Plan Update Date Tue, 17 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan Variant 70525AR0070286-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.705111667
Begin Primary Care Cost-Sharing After Number Of Visits 0
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 Silver Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, Pregnancy
EHB Percent of Total Premium 0.9999
First Tier Utilization 100%
Formulary ID ARF004
Formulary URL URL
HIOS Product ID 70525AR007
Import Date 8/17/2021 20:00
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? No
Issuer Actuarial Value 70.26%
Issuer ID 70525
Issuer Marketplace Marketing Name Ambetter from Arkansas Health & Wellness
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID ARN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Medical benefits are subject to out-of-network cost sharing and limitations
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 70525AR0070286-00
Plan Marketing Name Ambetter Balanced Care 26 (QualChoice)
Plan Type POS
Plan Variant Marketing Name Ambetter Balanced Care 26 (QualChoice)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,000
SBC Scenario, Having a Baby, Copayment $400
SBC Scenario, Having a Baby, Deductible $5,450
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,200
SBC Scenario, Having Diabetes, Deductible $800
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ARS001
Source Name SERFF
Plan ID 70525AR0070286
State Code AR
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $41200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $20600 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $20,600
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $25900 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $12950 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $12,950
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $10900 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5450 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,450
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $15000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $7500 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $7,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $16200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,100
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $25000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $12500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $12,500
Unique Plan Design Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan, 70525AR0070286

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

Frequently Asked Questions(FAQ) about Ambetter Balanced Care 26 (QualChoice), 70525AR0070286 Health Insurance Plan, 70525AR0070286

  • Does Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan, 70525AR0070286 support Mail Ordering?

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

  • Does (70525AR0070286) Health Insurance Plan, Variant (70525AR0070286-00) offer Disease Management Programs?

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

    Does (70525AR0070286) Health Insurance Plan, Variant (70525AR0070286-00) have Out Of Country Coverage?

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

    Does (70525AR0070286) Health Insurance Plan, Variant (70525AR0070286-00) have Out of Service Area Coverage?

    Yes. Details: Medical benefits are subject to out-of-network cost sharing and limitations

    Does (70525AR0070286) Health Insurance Plan, Variant (70525AR0070286-00) offer Disease Management Programs?

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

    Does Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan, Variant (70525AR0070286-00) offer Disease Management Programs for Asthma?

    Yes, the Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan Variant 70525AR0070286-00 offers Disease Management Program for Asthma.

    Does Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan, Variant (70525AR0070286-00) offer Disease Management Programs for Heart disease?

    Yes, the Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan Variant 70525AR0070286-00 offers Disease Management Program for Heart disease.

    Does Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan, Variant (70525AR0070286-00) offer Disease Management Programs for Diabetes?

    Yes, the Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan Variant 70525AR0070286-00 offers Disease Management Program for Diabetes.

    Does Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan, Variant (70525AR0070286-00) offer Disease Management Programs for Pregnancy?

    Yes, the Ambetter Balanced Care 26 (QualChoice) Health Insurance Plan Variant 70525AR0070286-00 offers Disease Management Program for Pregnancy.

 

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