BlueKC Community Silver 6000 with broad Preferred-Care Blue EPO - 34762MO0590009 Health Insurance Plan
Blue Cross and Blue Shield of Kansas City health insurance plan with the Plan ID 34762MO0590009. The plan is called BlueKC Community Silver 6000 with broad Preferred-Care Blue EPO.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 68.54% (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 31.46% 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 | 34762MO0590009 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Missouri | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross and Blue Shield of Kansas City | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 34762MO0590009-01 | ||||||||||||||||||
| Provider Network(s) | ['MON001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Apr 2024 06:19 GMT). |
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| Available Variants of the Health Plan | Standard On Exchange Plan - 34762MO0590009-01 Open to Indians below 300% FPL - 34762MO0590009-02 Open to Indians above 300% FPL - 34762MO0590009-03 73% AV Silver Plan - 34762MO0590009-04 |
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| Last Plan Update Date | Thu, 02 Dec 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Apr 2024 06:19 GMT |
Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan Variant 34762MO0590009-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.685357055 |
| 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 | Standard Silver On Exchange Plan |
| Dental Only Plan | No |
| 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 | MOF005 |
| Formulary URL | URL |
| HIOS Product ID | 34762MO059 |
| Import Date | 12/2/2021 1:01 |
| 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 | 34762 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Kansas City |
| 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 | MON001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | Services are not provided out-of-network, except in an Emergency, Urgent Care, or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 34762MO0590009-01 |
| Plan Level Exclusions | Services received from Out-of-Network Providers except as specified. Services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. Services You are entitled to at no cost for military service related conditions. Losses due in whole or in part to war/any action of war. Court ordered services, including but not limited to examinations, treatment, and genetic testing. Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. Hairplasty or hair removal, regardless of reason or diagnosis. Health/dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. Except as provided for charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Services which are related to complications arising from treatments or services otherwise excluded. Non-prescription enteral feedings and other nutritional and electrolyte supplements. Diagnosis/treatment of impotency, including drugs. Services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. Sales tax. Services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare. |
| Plan Marketing Name | BlueKC Community Silver 6000 with broad Preferred-Care Blue EPO |
| Plan Type | EPO |
| Plan Variant Marketing Name | Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO |
| QHP/Non QHP | On the Exchange |
| SBC Scenario, Having a Baby, Coinsurance | $1,100 |
| SBC Scenario, Having a Baby, Copayment | $70 |
| SBC Scenario, Having a Baby, Deductible | $6,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,400 |
| 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 | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,600 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MOS001 |
| Source Name | HIOS |
| Plan ID | 34762MO0590009 |
| 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 | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $12000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $6000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $6,000 |
| 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 | $16200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8100 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,100 |
| 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 BlueKC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, 34762MO0590009
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about BlueKC Community Silver 6000 with broad Preferred-Care Blue EPO, 34762MO0590009 Health Insurance Plan, 34762MO0590009
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Does BlueKC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, 34762MO0590009 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (34762MO0590009) Health Insurance Plan, Variant (34762MO0590009-01) 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 (34762MO0590009) Health Insurance Plan, Variant (34762MO0590009-01) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (34762MO0590009) Health Insurance Plan, Variant (34762MO0590009-01) have Out of Service Area Coverage?
No, unfortunately there
is no Out of Service Area Coverage for this Health Insurance
Plan (variant of plan). Details: Services are not provided out-of-network, except in an Emergency, Urgent Care, or other limited situations. If an out-of-network service is covered and provided outside of Our Service Area, such services will be provided at the in-network benefit level. Non-emergency services that are covered out-of-network will not apply to your in-network out-of-pocket maximum.
Does (34762MO0590009) Health Insurance Plan, Variant (34762MO0590009-01) 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 Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, Variant (34762MO0590009-01) offer Disease Management Programs for Asthma?
Yes, the Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan Variant
34762MO0590009-01 offers Disease
Management Program for Asthma.
Does Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, Variant (34762MO0590009-01) offer Disease Management Programs for Heart disease?
Yes, the Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan Variant
34762MO0590009-01 offers Disease
Management Program for Heart disease.
Does Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, Variant (34762MO0590009-01) offer Disease Management Programs for Depression?
Yes, the Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan Variant
34762MO0590009-01 offers Disease
Management Program for Depression.
Does Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, Variant (34762MO0590009-01) offer Disease Management Programs for Diabetes?
Yes, the Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan Variant
34762MO0590009-01 offers Disease
Management Program for Diabetes.
Does Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, Variant (34762MO0590009-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan Variant
34762MO0590009-01 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan, Variant (34762MO0590009-01) offer Disease Management Programs for Pregnancy?
Yes, the Blue KC Community Silver 6000 with broad Preferred-Care Blue EPO Health Insurance Plan Variant
34762MO0590009-01 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 16 Apr 2024 06:19 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