Ambetter Value Silver 30 - 86382FL0050007 Health Insurance Plan

Sunshine State Health Plan health insurance plan with the Plan ID 86382FL0050007. The plan is called Ambetter Value Silver 30.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 72.03% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 27.97% 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 72.03% (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 27.97% 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 86382FL0050007
Health Insurance Plan Year 2022
State Florida
Health Insurance Issuer Sunshine State Health Plan
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 86382FL0050007-04
Provider Network(s) ['FLN002']
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 Florida 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 - 86382FL0050007-00

Standard On Exchange Plan - 86382FL0050007-01

Open to Indians below 300% FPL - 86382FL0050007-02

Open to Indians above 300% FPL - 86382FL0050007-03

73% AV Silver Plan - 86382FL0050007-04

87% AV Silver Plan - 86382FL0050007-05

94% AV Silver Plan - 86382FL0050007-06

Last Plan Update Date Sat, 14 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Ambetter Value Silver 30 Health Insurance Plan Variant 86382FL0050007-04 Attributes

Plan Attribute Value
AV Calculator Output Number 0.720311714
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 73% AV Level Silver Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID FLF003
Formulary URL URL
HIOS Product ID 86382FL005
Import Date 8/14/2021 0:43
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? Yes
Issuer Actuarial Value 72.03%
Issuer ID 86382
Issuer Marketplace Marketing Name Ambetter from Sunshine Health
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 FLN002
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) 86382FL0050007-04
Plan Marketing Name Ambetter Value Silver 30
Plan Type HMO
Plan Variant Marketing Name Ambetter Value Silver 30
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $4,200
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $4,200
SBC Scenario, Having Diabetes, Limit $20
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 $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID FLS002
Source Name HIOS
Specialist Requiring a Referral All except for mental or behavioral health services, obstetrical or gynecological treatment.
Plan ID 86382FL0050007
State Code FL
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 $8400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $4200 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $4,200
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 $8400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $4200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $4,200
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

Copay & Coinsurance of Ambetter Value Silver 30 Health Insurance Plan, 86382FL0050007

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

Frequently Asked Questions(FAQ) about Ambetter Value Silver 30, 86382FL0050007 Health Insurance Plan, 86382FL0050007

  • Does Ambetter Value Silver 30 Health Insurance Plan, 86382FL0050007 support Mail Ordering?

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

  • Does (86382FL0050007) Health Insurance Plan, Variant (86382FL0050007-04) offer Disease Management Programs?

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

    Does (86382FL0050007) Health Insurance Plan, Variant (86382FL0050007-04) have Out Of Country Coverage?

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

    Does (86382FL0050007) Health Insurance Plan, Variant (86382FL0050007-04) 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 (86382FL0050007) Health Insurance Plan, Variant (86382FL0050007-04) offer Disease Management Programs?

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

    Does Ambetter Value Silver 30 Health Insurance Plan, Variant (86382FL0050007-04) offer Disease Management Programs for Asthma?

    Yes, the Ambetter Value Silver 30 Health Insurance Plan Variant 86382FL0050007-04 offers Disease Management Program for Asthma.

    Does Ambetter Value Silver 30 Health Insurance Plan, Variant (86382FL0050007-04) offer Disease Management Programs for Heart disease?

    Yes, the Ambetter Value Silver 30 Health Insurance Plan Variant 86382FL0050007-04 offers Disease Management Program for Heart disease.

    Does Ambetter Value Silver 30 Health Insurance Plan, Variant (86382FL0050007-04) offer Disease Management Programs for Diabetes?

    Yes, the Ambetter Value Silver 30 Health Insurance Plan Variant 86382FL0050007-04 offers Disease Management Program for Diabetes.

    Does Ambetter Value Silver 30 Health Insurance Plan, Variant (86382FL0050007-04) offer Disease Management Programs for Pregnancy?

    Yes, the Ambetter Value Silver 30 Health Insurance Plan Variant 86382FL0050007-04 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