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BCBSVT Vermont Preferred Bronze Plan - 13627VT0360007 Health Insurance Plan

13627 health insurance plan with the Plan ID 13627VT0360007. The plan is called BCBSVT Vermont Preferred Bronze Plan.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.30% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.70% 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 62.82% (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 37.18% 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 ID13627VT0360007
Health Insurance Plan Year2023
StateVermont
Health Insurance Issuer13627
Last Plan Update DateMon, 23 Jan 2023 00:00 GMT
Last Import DateSun, 01 Oct 2023 10:53 GMT
Health Insurance Plan Variant13627VT0360007-01
 
Available Variants of the Health Plan

13627VT0360007-01

BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 Attributes
Plan Attribute Value
AV Calculator Output Number0.628191816
Begin Primary Care Cost-Sharing After Number Of Visits4
Business Year2023
Child-Only OfferingAllows Adult and Child-Only
Composite Rating OfferedNo
CSR Variation TypeStandard Bronze On Exchange Plan
Dental Only PlanNo
Disease Management Programs OfferedAsthma, Heart Disease, Depression, Diabetes, Pain Management, Pregnancy, High Blood Pressure & High Cholesterol
First Tier Utilization100%
Formulary IDVTF019
HIOS Product ID13627VT036
HSA/HRA Employer ContributionNo
Import Date1/23/2023
HSA EligibleNo
IsItANewPlanExisting
Notice Required for PregnancyNo
Is a Referral Required for Specialist?No
Issuer Actuarial Value64.30%
Issuer ID13627
Market CoverageSHOP (Small Group)
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelExpanded Bronze
Multiple In Network TiersNo
National NetworkYes
Network IDVTN001
Out of Country CoverageYes
Out of Country Coverage DescriptionAll members traveling outside the U.S. have access to the BlueCard Worldwide program.
Out of Service Area CoverageYes
Out of Service Area Coverage DescriptionMembers may use preferred providers nationally through the BlueCard network.
Plan Effective Date1/1/2023
Plan Expiration Date12/31/2023
Plan ID (Standard Component ID with Variant) 13627VT0360007-01
Plan Marketing NameBCBSVT Vermont Preferred Bronze Plan
Plan TypeEPO
Plan Variant Marketing NameBCBSVT Vermont Preferred Bronze Plan
QHP/Non QHPOn the Exchange
SBC Scenario, Having a Baby, Coinsurance$0
SBC Scenario, Having a Baby, Copayment$0
SBC Scenario, Having a Baby, Deductible$8,950
SBC Scenario, Having a Baby, Limit$50
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$0
SBC Scenario, Having Diabetes, Deductible$5,420
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$2,640
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Service Area IDVTS001
Source NameSERFF
Plan ID13627VT0360007
State CodeVT
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Familyper person not applicable | per group 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, Familyper person not applicable | per group 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 Coinsurance0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family$8950 per person | $17900 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$8,950
Combined Medical and Drug EHB Deductible, Out of Network, Familyper person not applicable | per group 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$8950 per person | $17900 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual$8,950
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Familyper person not applicable | per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, IndividualNot Applicable
Unique Plan DesignYes
Version Number1
Wellness Program OfferedYes

Copay & Coinsurance of BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, 13627VT0360007
Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about BCBSVT Vermont Preferred Bronze Plan, 13627VT0360007 Health Insurance Plan, 13627VT0360007

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, 13627VT0360007 support Mail Ordering?

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

Does (13627VT0360007) Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs?

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

Does (13627VT0360007) Health Insurance Plan, Variant (13627VT0360007-01) have Out Of Country Coverage?

Yes. Details: All members traveling outside the U.S. have access to the BlueCard Worldwide program.

Does (13627VT0360007) Health Insurance Plan, Variant (13627VT0360007-01) have Out of Service Area Coverage?

Yes. Details: Members may use preferred providers nationally through the BlueCard network.

Does (13627VT0360007) Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs?

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

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs for Asthma?

Yes, the BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 offers Disease Management Program for Asthma.

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs for Heart disease?

Yes, the BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 offers Disease Management Program for Heart disease.

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs for Depression?

Yes, the BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 offers Disease Management Program for Depression.

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs for Diabetes?

Yes, the BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 offers Disease Management Program for Diabetes.

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs for High blood pressure & high cholesterol?

Yes, the BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 offers Disease Management Program for High blood pressure & high cholesterol.

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs for Pain management?

Yes, the BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 offers Disease Management Program for Pain management.

Does BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan, Variant (13627VT0360007-01) offer Disease Management Programs for Pregnancy?

Yes, the BCBSVT Vermont Preferred Bronze Plan Health Insurance Plan Variant 13627VT0360007-01 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Sun, 01 Oct 2023 10:53 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