Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health - 11512NC0320011 Health Insurance Plan

Blue Cross and Blue Shield of NC health insurance plan with the Plan ID 11512NC0320011. The plan is called Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.95% (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 28.05% 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 11512NC0320011
Health Insurance Plan Year 2022
State North Carolina
Health Insurance Issuer Blue Cross and Blue Shield of NC
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 11512NC0320011-00
Provider Network(s) ['NCN006']
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 North Carolina 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 - 11512NC0320011-00

Standard On Exchange Plan - 11512NC0320011-01

Open to Indians below 300% FPL - 11512NC0320011-02

Open to Indians above 300% FPL - 11512NC0320011-03

73% AV Silver Plan - 11512NC0320011-04

87% AV Silver Plan - 11512NC0320011-05

94% AV Silver Plan - 11512NC0320011-06

Last Plan Update Date Thu, 19 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan Variant 11512NC0320011-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.71953041
Begin Primary Care Cost-Sharing After Number Of Visits 3
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 Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person $350 per person
Drug EHB Deductible, Combined In/Out of Network, Individual $350
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 40.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group per group not applicable
Drug EHB Deductible, In Network (Tier 1), Family Per Person $350 per person
Drug EHB Deductible, In Network (Tier 1), Individual $350
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person $350 per person
Drug EHB Deductible, Out of Network, Individual $350
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID NCF006
Formulary URL URL
HIOS Product ID 11512NC032
Import Date 8/19/2021 15:35
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 No
Is a Referral Required for Specialist? No
Issuer ID 11512
Issuer Marketplace Marketing Name Blue Cross and Blue Shield of NC
Market Coverage Individual
Medical Drug Deductibles Integrated No
Medical Drug Maximum Out of Pocket Integrated Yes
Medical EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 40.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $7600 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $3800 per person
Medical EHB Deductible, In Network (Tier 1), Individual $3,800
Medical EHB Deductible, Out of Network, Family Per Group $38000 per group
Medical EHB Deductible, Out of Network, Family Per Person $19000 per person
Medical EHB Deductible, Out of Network, Individual $19,000
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID NCN006
Out of Country Coverage Yes
Out of Country Coverage Description Out of Network Benefits will Apply
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Out of Network Benefits will Apply
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 11512NC0320011-00
Plan Marketing Name Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health
Plan Type POS
Plan Variant Marketing Name Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,500
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $3,800
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $800
SBC Scenario, Having Diabetes, Deductible $1,300
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $400
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID NCS050
Source Name HIOS
Plan ID 11512NC0320011
State Code NC
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
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
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 Yes

Copay & Coinsurance of Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, 11512NC0320011

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

Frequently Asked Questions(FAQ) about Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health, 11512NC0320011 Health Insurance Plan, 11512NC0320011

  • Does Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, 11512NC0320011 support Mail Ordering?

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

  • Does (11512NC0320011) Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs?

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

    Does (11512NC0320011) Health Insurance Plan, Variant (11512NC0320011-00) have Out Of Country Coverage?

    Yes. Details: Out of Network Benefits will Apply

    Does (11512NC0320011) Health Insurance Plan, Variant (11512NC0320011-00) have Out of Service Area Coverage?

    Yes. Details: Out of Network Benefits will Apply

    Does (11512NC0320011) Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs?

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

    Does Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs for Asthma?

    Yes, the Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan Variant 11512NC0320011-00 offers Disease Management Program for Asthma.

    Does Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs for Heart disease?

    Yes, the Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan Variant 11512NC0320011-00 offers Disease Management Program for Heart disease.

    Does Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs for Diabetes?

    Yes, the Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan Variant 11512NC0320011-00 offers Disease Management Program for Diabetes.

    Does Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan Variant 11512NC0320011-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs for Pregnancy?

    Yes, the Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan Variant 11512NC0320011-00 offers Disease Management Program for Pregnancy.

    Does Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan, Variant (11512NC0320011-00) offer Disease Management Programs for Weight loss programs?

    Yes, the Blue Local Silver 3800 + 3 Free PCP with Wake Forest Baptist Health Health Insurance Plan Variant 11512NC0320011-00 offers Disease Management Program for Weight loss programs.

 

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