Ambetter Essential Care: $1,500 Medical Deductible - 62141AR0080025 Health Insurance Plan
Celtic Insurance Company health insurance plan with the Plan ID 62141AR0080025. The plan is called Ambetter Essential Care: $1,500 Medical Deductible.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 63.81% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 36.19% 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 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 | 62141AR0080025 | ||||||||||||||||||
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| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Arkansas | ||||||||||||||||||
| Health Insurance Issuer | Celtic Insurance Company | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 62141AR0080025-00 | ||||||||||||||||||
| Provider Network(s) | ['ARN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 09 Apr 2024 06:01 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 62141AR0080025-00 Standard On Exchange Plan - 62141AR0080025-01 |
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| Last Plan Update Date | Wed, 18 Aug 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 09 Apr 2024 06:01 GMT |
Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan Variant 62141AR0080025-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.649830347 |
| 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 Bronze Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $7600 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $3800 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $3,800 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| 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 | ARF003 |
| Formulary URL | URL |
| HIOS Product ID | 62141AR008 |
| Import Date | 8/18/2021 20:00 |
| 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 | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 63.81% |
| Issuer ID | 62141 |
| Issuer Marketplace Marketing Name | Ambetter from Arkansas Health & Wellness |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | $23000 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $11500 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $11,500 |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $3000 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $1500 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $1,500 |
| Medical EHB Deductible, Out of Network, Family Per Group | $20000 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $10000 per person |
| Medical EHB Deductible, Out of Network, Individual | $10,000 |
| Metal Level | Expanded Bronze |
| 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 | PPO Plan - out of network limitations apply |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan ID (Standard Component ID with Variant) | 62141AR0080025-00 |
| Plan Marketing Name | Ambetter Essential Care: $1,500 Medical Deductible |
| Plan Type | PPO |
| Plan Variant Marketing Name | Ambetter Essential Care: $1,500 Medical Deductible |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $3,600 |
| 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 | $700 |
| SBC Scenario, Having Diabetes, Deductible | $4,300 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ARS001 |
| Source Name | SERFF |
| Plan ID | 62141AR0080025 |
| State Code | AR |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $47400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $23700 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $23,700 |
| 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 | $30000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $15000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $15,000 |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan, 62141AR0080025
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Ambetter Essential Care: $1,500 Medical Deductible, 62141AR0080025 Health Insurance Plan, 62141AR0080025
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Does Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan, 62141AR0080025 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (62141AR0080025) Health Insurance Plan, Variant (62141AR0080025-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does (62141AR0080025) Health Insurance Plan, Variant (62141AR0080025-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (62141AR0080025) Health Insurance Plan, Variant (62141AR0080025-00) have Out of Service Area Coverage?
Yes. Details: PPO Plan - out of network limitations apply
Does (62141AR0080025) Health Insurance Plan, Variant (62141AR0080025-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan, Variant (62141AR0080025-00) offer Disease Management Programs for Asthma?
Yes, the Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan Variant
62141AR0080025-00 offers Disease
Management Program for Asthma.
Does Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan, Variant (62141AR0080025-00) offer Disease Management Programs for Heart disease?
Yes, the Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan Variant
62141AR0080025-00 offers Disease
Management Program for Heart disease.
Does Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan, Variant (62141AR0080025-00) offer Disease Management Programs for Diabetes?
Yes, the Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan Variant
62141AR0080025-00 offers Disease
Management Program for Diabetes.
Does Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan, Variant (62141AR0080025-00) offer Disease Management Programs for Pregnancy?
Yes, the Ambetter Essential Care: $1,500 Medical Deductible Health Insurance Plan Variant
62141AR0080025-00 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 09 Apr 2024 06:01 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