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Ambetter Secure Care 20 - 99723MO0090064 Health Insurance Plan

Celtic Insurance Company health insurance plan with the Plan ID 99723MO0090064. The plan is called Ambetter Secure Care 20.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 77.39% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 22.61% 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 78.02% (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 21.98% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Field Data
Health Insurance Plan ID99723MO0090064
Health Insurance Plan Year2022
StateMissouri
Health Insurance IssuerCeltic Insurance Company
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateFri, 13 Aug 2021 00:00 GMT
Last Import DateSun, 24 Sep 2023 09:34 GMT
Health Insurance Plan Variant99723MO0090064-00
 
Available Variants of the Health Plan

99723MO0090064-00

99723MO0090064-01

99723MO0090064-02

99723MO0090064-03

Ambetter Secure Care 20 Health Insurance Plan Variant 99723MO0090064-00 Attributes

Plan Attribute Value
AV Calculator Output Number0.780236057
Begin Primary Care Cost-Sharing After Number Of Visits0
Begin Primary Care Deductible Coinsurance After Number Of Copays0
Business Year2022
Child-Only OfferingAllows Adult and Child-Only
Composite Rating OfferedNo
CSR Variation TypeStandard Gold Off Exchange Plan
Dental Only PlanNo
Disease Management Programs OfferedAsthma, Heart Disease, Diabetes, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization100%
Formulary IDMOF011
Formulary URLURL
HIOS Product ID99723MO009
Import Date8/13/2021 1:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment$0.00
Inpatient Copayment Maximum Days0
HSA EligibleNo
New/Existing PlanNew
Notice Required for PregnancyYes
Is a Referral Required for Specialist?No
Issuer Actuarial Value77.39%
Issuer ID99723
Issuer Marketplace Marketing NameAmbetter from Home State Health
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelGold
Multiple In Network TiersNo
National NetworkNo
Network IDMON001
Out of Country CoverageNo
Out of Service Area CoverageNo
Plan BrochureURL
Plan Effective Date1/1/2022
Plan ID (Standard Component ID with Variant) 99723MO0090064-00
Plan Marketing NameAmbetter Secure Care 20
Plan TypeEPO
Plan Variant Marketing NameAmbetter Secure Care 20
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$1,500
SBC Scenario, Having a Baby, Copayment$300
SBC Scenario, Having a Baby, Deductible$1,450
SBC Scenario, Having a Baby, Limit$60
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$800
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$200
SBC Scenario, Treatment of a Simple Fracture, Deductible$1,450
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Service Area IDMOS002
Source NameHIOS
Plan ID99723MO0090064
State CodeMO
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, IndividualNot Applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Groupper group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Personper person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, IndividualNot Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance35.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group$1500 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$750 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$750
TEHBDedOutOfNetFamilyPerGroupper group not applicable
TEHBDedOutOfNetFamilyPerPersonper person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, IndividualNot Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group$15000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person$7500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual$7,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, IndividualNot Applicable
Unique Plan DesignYes
URL for Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program OfferedNo

Copay & Coinsurance of Ambetter Secure Care 20 Health Insurance Plan, 99723MO0090064

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

Frequently Asked Questions(FAQ) about Ambetter Secure Care 20, 99723MO0090064 Health Insurance Plan, 99723MO0090064

Does Ambetter Secure Care 20 Health Insurance Plan, 99723MO0090064 support Mail Ordering?

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

Does (99723MO0090064) Health Insurance Plan, Variant (99723MO0090064-00) offer Disease Management Programs?

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

Does (99723MO0090064) Health Insurance Plan, Variant (99723MO0090064-00) have Out Of Country Coverage?

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

Does (99723MO0090064) Health Insurance Plan, Variant (99723MO0090064-00) have Out of Service Area Coverage?

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

Does (99723MO0090064) Health Insurance Plan, Variant (99723MO0090064-00) offer Disease Management Programs?

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

Does Ambetter Secure Care 20 Health Insurance Plan, Variant (99723MO0090064-00) offer Disease Management Programs for Asthma?

Yes, the Ambetter Secure Care 20 Health Insurance Plan Variant 99723MO0090064-00 offers Disease Management Program for Asthma.

Does Ambetter Secure Care 20 Health Insurance Plan, Variant (99723MO0090064-00) offer Disease Management Programs for Heart disease?

Yes, the Ambetter Secure Care 20 Health Insurance Plan Variant 99723MO0090064-00 offers Disease Management Program for Heart disease.

Does Ambetter Secure Care 20 Health Insurance Plan, Variant (99723MO0090064-00) offer Disease Management Programs for Diabetes?

Yes, the Ambetter Secure Care 20 Health Insurance Plan Variant 99723MO0090064-00 offers Disease Management Program for Diabetes.

Does Ambetter Secure Care 20 Health Insurance Plan, Variant (99723MO0090064-00) offer Disease Management Programs for Pregnancy?

Yes, the Ambetter Secure Care 20 Health Insurance Plan Variant 99723MO0090064-00 offers Disease Management Program for Pregnancy.

 

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