| Field | Data |
|---|---|
| Health Insurance Plan ID | 57601NH0350001 |
| Health Insurance Plan Year | 2023 |
| State | New Hampshire |
| Health Insurance Issuer | Anthem Health Plans of NH(Anthem BCBS) |
| Last Plan Update Date | Sat, 13 May 2023 00:00 GMT |
| Last Import Date | Sun, 28 May 2023 07:51 GMT |
| Health Insurance Plan Variant | 57601NH0350001-01 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.633820964 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pregnancy |
| First Tier Utilization | 51% |
| Formulary ID | NHF003 |
| Formulary URL | URL |
| HIOS Product ID | 57601NH035 |
| HSA/HRA Employer Contribution | No |
| Import Date | 8/17/2022 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | Yes |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 63.74% |
| Issuer ID | 57601 |
| Issuer Marketplace Marketing Name | Anthem Blue Cross and Blue Sheld |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | Yes |
| Network ID | NHN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Full Access |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Standard Bluecard PPO Network |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 57601NH0350001-01 |
| Plan Marketing Name | Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA |
| Plan Type | PPO |
| Plan Variant Marketing Name | Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,000 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $6,500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,400 |
| 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 |
| Second Tier Utilization | 49% |
| Service Area ID | NHS002 |
| Source Name | SERFF |
| Specialty Drug Maximum Coinsurance | $650 |
| Plan ID | 57601NH0350001 |
| State Code | NH |
| 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 | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $13000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $6500 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $6,500 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $13000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $6500 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $6,500 |
| TEHBDedOutOfNetFamilyPerGroup | $26000 per group |
| TEHBDedOutOfNetFamilyPerPerson | $13000 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $13,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $14900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7450 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,450 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $14900 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $7450 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $7,450 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $29800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $14900 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $14,900 |
| Unique Plan Design | Yes |
| 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 Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA, 57601NH0350001 Health Insurance Plan, 57601NH0350001
Does Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan, 57601NH0350001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (57601NH0350001) Health Insurance Plan, Variant (57601NH0350001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does (57601NH0350001) Health Insurance Plan, Variant (57601NH0350001-01) have Out Of Country Coverage?
Yes. Details: Full Access
Does (57601NH0350001) Health Insurance Plan, Variant (57601NH0350001-01) have Out of Service Area Coverage?
Yes. Details: Standard Bluecard PPO Network
Does (57601NH0350001) Health Insurance Plan, Variant (57601NH0350001-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy
Does Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan, Variant (57601NH0350001-01) offer Disease Management Programs for Asthma?
Yes, the Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan Variant 57601NH0350001-01 offers Disease Management Program for Asthma.
Does Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan, Variant (57601NH0350001-01) offer Disease Management Programs for Heart disease?
Yes, the Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan Variant 57601NH0350001-01 offers Disease Management Program for Heart disease.
Does Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan, Variant (57601NH0350001-01) offer Disease Management Programs for Depression?
Yes, the Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan Variant 57601NH0350001-01 offers Disease Management Program for Depression.
Does Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan, Variant (57601NH0350001-01) offer Disease Management Programs for Diabetes?
Yes, the Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan Variant 57601NH0350001-01 offers Disease Management Program for Diabetes.
Does Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan, Variant (57601NH0350001-01) offer Disease Management Programs for Pregnancy?
Yes, the Anthem Bronze Preferred Blue PPO 6500/50%/7450 w/HSA Health Insurance Plan Variant 57601NH0350001-01 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