| Field | Data |
|---|---|
| Health Insurance Plan ID | 99723MO0110063 |
| Health Insurance Plan Year | 2022 |
| State | Missouri |
| Health Insurance Issuer | Celtic Insurance Company |
| Last Plan Update Date | Tue, 27 Jul 2021 00:00 GMT |
| Last Import Date | Sun, 28 May 2023 07:51 GMT |
| Health Insurance Plan Variant | 99723MO0110063-03 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.780236057 |
| 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 | Limited Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, Pregnancy |
| EHB Percent of Total Premium | 0.9675 |
| First Tier Utilization | 100% |
| Formulary ID | MOF011 |
| Formulary URL | URL |
| HIOS Product ID | 99723MO011 |
| Import Date | 8/13/2021 1:01 |
| 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 | Yes |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 77.39% |
| Issuer ID | 99723 |
| Issuer Marketplace Marketing Name | Ambetter from Home State Health |
| 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 | MON001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan ID (Standard Component ID with Variant) | 99723MO0110063-03 |
| Plan Marketing Name | Ambetter Secure Care 20 + Vision + Adult Dental |
| Plan Type | EPO |
| Plan Variant Marketing Name | Ambetter Secure Care 20 + Vision + Adult Dental |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MOS001 |
| Source Name | HIOS |
| Plan ID | 99723MO0110063 |
| State Code | MO |
| 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 | 35.00% |
| 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 |
| TEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| TEHBDedOutOfNetFamilyPerPerson | 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 | $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 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 | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Everyday Gold + Vision + Adult Dental, 99723MO0110063 Health Insurance Plan, 99723MO0110063
Does Everyday Gold + Vision + Adult Dental Health Insurance Plan, 99723MO0110063 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (99723MO0110063) Health Insurance Plan, Variant (99723MO0110063-03) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does (99723MO0110063) Health Insurance Plan, Variant (99723MO0110063-03) have Out Of Country Coverage?
No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).
Does (99723MO0110063) Health Insurance Plan, Variant (99723MO0110063-03) 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 (99723MO0110063) Health Insurance Plan, Variant (99723MO0110063-03) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan, Variant (99723MO0110063-03) offer Disease Management Programs for Asthma?
Yes, the Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan Variant 99723MO0110063-03 offers Disease Management Program for Asthma.
Does Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan, Variant (99723MO0110063-03) offer Disease Management Programs for Heart disease?
Yes, the Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan Variant 99723MO0110063-03 offers Disease Management Program for Heart disease.
Does Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan, Variant (99723MO0110063-03) offer Disease Management Programs for Diabetes?
Yes, the Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan Variant 99723MO0110063-03 offers Disease Management Program for Diabetes.
Does Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan, Variant (99723MO0110063-03) offer Disease Management Programs for Pregnancy?
Yes, the Ambetter Secure Care 20 + Vision + Adult Dental Health Insurance Plan Variant 99723MO0110063-03 offers Disease Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Sun, 28 May 2023 07:51 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