Ascension Personalized Care No Deductible Silver - 58996MI0700006 Health Insurance Plan

US Health and Life Insurance Company health insurance plan with the Plan ID 58996MI0700006. The plan is called Ascension Personalized Care No Deductible Silver.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.88% (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 29.12% 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 58996MI0700006
Health Insurance Plan Year 2023
State Michigan
Health Insurance Issuer US Health and Life Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 58996MI0700006-00
Provider Network(s) ['MIN001']
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 Michigan 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 - 58996MI0700006-00

Standard On Exchange Plan - 58996MI0700006-01

Open to Indians below 300% FPL - 58996MI0700006-02

Open to Indians above 300% FPL - 58996MI0700006-03

73% AV Silver Plan - 58996MI0700006-04

87% AV Silver Plan - 58996MI0700006-05

94% AV Silver Plan - 58996MI0700006-06

Last Plan Update Date Wed, 31 Aug 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Ascension Personalized Care No Deductible Silver Health Insurance Plan, 58996MI0700006-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
NO
Acupuncture
NO
Allergy Testing
YES

$100.00

100.00%
Bariatric Surgery

Limit: 1.0 Procedure(s) per Lifetime

YES

$2,000.00

100.00%
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy
YES

40.00%

100.00%
Chiropractic Care

Limit: 30.0 Visit(s) per Year

Limit combined with OT and PT.

YES

40.00%

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

$2,000.00

100.00%
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

NO
Diabetes Education
YES

40.00%

100.00%
Dialysis
YES

40.00%

100.00%
Durable Medical Equipment
YES

40.00%

100.00%
Emergency Room Services
YES

$1,000.00

$1,000.00
Emergency Transportation/Ambulance
YES

$1,000.00

$1,000.00
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

40.00%

100.00%
Gender Affirming Care
NO
Generic Drugs
YES

$25.00

100.00%
Habilitation Services

Limit: 30.0 Visit(s) per Year

Yearly limits: PT and OT: 30 visits, Speech: 30 visits.

YES

$100.00

100.00%
Hearing Aids
NO
Home Health Care Services
YES

40.00%

100.00%
Hospice Services

Coverage includes inpatient and outpatient hospice care.

YES

$2,000.00

100.00%
Imaging (CT/PET Scans, MRIs)
YES

$200.00

100.00%
Infertility Treatment

Underlying causes only.

YES

40.00%

100.00%
Infusion Therapy
YES

40.00%

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

$2000.00 Copay per Day

100.00%
Inpatient Physician and Surgical Services
YES

No Charge

100.00%
Laboratory Outpatient and Professional Services
YES

$100.00

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

$2000.00 Copay per Day

100.00%
Mental/Behavioral Health Outpatient Services
YES

$30.00

100.00%
Non-Preferred Brand Drugs
YES

50.00%

100.00%
Nutritional Counseling

Limit: 6.0 Visit(s) per Year

Dietician Services.

YES

40.00%

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

$60.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

$1,000.00

100.00%
Outpatient Rehabilitation Services

Limit: 30.0 Visit(s) per Year

PT/OT/Chiro - combined visits per contract year; 30 ST per contract year; 30 cardiac/pulmonary visits per contract year.

YES

$100.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

$100.00

100.00%
Preferred Brand Drugs
YES

$100.00

100.00%
Prenatal and Postnatal Care
YES

$30.00

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

$30.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

40.00%

100.00%
Radiation
YES

40.00%

100.00%
Reconstructive Surgery
YES

40.00%

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 30.0 Visit(s) per Year

Combined with chiro.

YES

$100.00

100.00%
Rehabilitative Speech Therapy

Limit: 30.0 Visit(s) per Year

YES

$100.00

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Year

YES

$30.00

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 45.0 Days per Year

YES

$2000.00 Copay per Day

100.00%
Specialist Visit
YES

$60.00

100.00%
Specialty Drugs
YES

50.00%

100.00%
Substance Abuse Disorder Inpatient Services
YES

$2000.00 Copay per Day

100.00%
Substance Abuse Disorder Outpatient Services
YES

$30.00

100.00%
Transplant
YES

40.00%

100.00%
Treatment for Temporomandibular Joint Disorders

Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental X-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.

YES

40.00%

100.00%
Urgent Care Centers or Facilities
YES

$100.00

100.00%
Weight Loss Programs
YES

40.00%

100.00%
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

$200.00

100.00%

Ascension Personalized Care No Deductible Silver Health Insurance Plan Variant 58996MI0700006-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.708815687
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 Silver Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID MIF006
Formulary URL URL
HIOS Product ID 58996MI070
Import Date 8/31/2022 20:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 58996
Issuer Marketplace Marketing Name US Health and Life
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 MIN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 58996MI0700006-00
Plan Marketing Name Ascension Personalized Care No Deductible Silver
Plan Type EPO
Plan Variant Marketing Name Ascension Personalized Care No Deductible Silver
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $3,000
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $1,900
SBC Scenario, Having Diabetes, Copayment $600
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $100
SBC Scenario, Treatment of a Simple Fracture, Copayment $1,900
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MIS001
Source Name SERFF
Plan ID 58996MI0700006
State Code MI
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 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
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 $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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 No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Ascension Personalized Care No Deductible Silver Health Insurance Plan, 58996MI0700006

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

Frequently Asked Questions(FAQ) about Ascension Personalized Care No Deductible Silver, 58996MI0700006 Health Insurance Plan, 58996MI0700006

  • Does Ascension Personalized Care No Deductible Silver Health Insurance Plan, 58996MI0700006 support Mail Ordering?

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

  • Does (58996MI0700006) Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does (58996MI0700006) Health Insurance Plan, Variant (58996MI0700006-00) have Out Of Country Coverage?

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

    Does (58996MI0700006) Health Insurance Plan, Variant (58996MI0700006-00) 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 (58996MI0700006) Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does Ascension Personalized Care No Deductible Silver Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs for Asthma?

    Yes, the Ascension Personalized Care No Deductible Silver Health Insurance Plan Variant 58996MI0700006-00 offers Disease Management Program for Asthma.

    Does Ascension Personalized Care No Deductible Silver Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs for Heart disease?

    Yes, the Ascension Personalized Care No Deductible Silver Health Insurance Plan Variant 58996MI0700006-00 offers Disease Management Program for Heart disease.

    Does Ascension Personalized Care No Deductible Silver Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs for Depression?

    Yes, the Ascension Personalized Care No Deductible Silver Health Insurance Plan Variant 58996MI0700006-00 offers Disease Management Program for Depression.

    Does Ascension Personalized Care No Deductible Silver Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs for Diabetes?

    Yes, the Ascension Personalized Care No Deductible Silver Health Insurance Plan Variant 58996MI0700006-00 offers Disease Management Program for Diabetes.

    Does Ascension Personalized Care No Deductible Silver Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Ascension Personalized Care No Deductible Silver Health Insurance Plan Variant 58996MI0700006-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Ascension Personalized Care No Deductible Silver Health Insurance Plan, Variant (58996MI0700006-00) offer Disease Management Programs for Pregnancy?

    Yes, the Ascension Personalized Care No Deductible Silver Health Insurance Plan Variant 58996MI0700006-00 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