| Field | Data |
|---|---|
| Health Insurance Plan ID | 37160ND2410005 |
| Health Insurance Plan Year | 2023 |
| State | North Dakota |
| Health Insurance Issuer | Blue Cross Blue Shield of North Dakota |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Thu, 24 Nov 2022 00:00 GMT |
| Last Import Date | Sun, 28 May 2023 07:51 GMT |
| Health Insurance Plan Variant | 37160ND2410005-01 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.793031803 |
| 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 Gold On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 100% |
| Formulary ID | NDF006 |
| Formulary URL | URL |
| HIOS Product ID | 37160ND241 |
| Import Date | 2/11/2023 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 | 37160 |
| Issuer Marketplace Marketing Name | Blue Cross Blue Shield of North Dakota |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | NDN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 37160ND2410005-01 |
| Plan Marketing Name | BlueCare 70 Gold |
| Plan Type | PPO |
| Plan Variant Marketing Name | BlueCare 70 Gold |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $3,200 |
| SBC Scenario, Having a Baby, Copayment | $30 |
| SBC Scenario, Having a Baby, Deductible | $2,000 |
| SBC Scenario, Having a Baby, Limit | $20 |
| SBC Scenario, Having Diabetes, Coinsurance | $50 |
| SBC Scenario, Having Diabetes, Copayment | $400 |
| SBC Scenario, Having Diabetes, Deductible | $200 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,000 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NDS001 |
| Source Name | HIOS |
| Plan ID | 37160ND2410005 |
| State Code | ND |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $52200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $26100 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $26,100 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $12000 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $6000 per person |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $6,000 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 30.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $4000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $2000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| TEHBDedOutOfNetFamilyPerGroup | $8000 per group |
| TEHBDedOutOfNetFamilyPerPerson | $4000 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $4,000 |
| 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 | $34800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $17400 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $17,400 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | Yes |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about BlueCare Gold 70, 37160ND2410005 Health Insurance Plan, 37160ND2410005
Does BlueCare Gold 70 Health Insurance Plan, 37160ND2410005 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (37160ND2410005) Health Insurance Plan, Variant (37160ND2410005-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol
Does (37160ND2410005) Health Insurance Plan, Variant (37160ND2410005-01) have Out Of Country Coverage?
Yes. Details: Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.
Does (37160ND2410005) Health Insurance Plan, Variant (37160ND2410005-01) have Out of Service Area Coverage?
Yes. Details: Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.
Does (37160ND2410005) Health Insurance Plan, Variant (37160ND2410005-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol
Does BlueCare 70 Gold Health Insurance Plan, Variant (37160ND2410005-01) offer Disease Management Programs for Asthma?
Yes, the BlueCare 70 Gold Health Insurance Plan Variant 37160ND2410005-01 offers Disease Management Program for Asthma.
Does BlueCare 70 Gold Health Insurance Plan, Variant (37160ND2410005-01) offer Disease Management Programs for Heart disease?
Yes, the BlueCare 70 Gold Health Insurance Plan Variant 37160ND2410005-01 offers Disease Management Program for Heart disease.
Does BlueCare 70 Gold Health Insurance Plan, Variant (37160ND2410005-01) offer Disease Management Programs for Diabetes?
Yes, the BlueCare 70 Gold Health Insurance Plan Variant 37160ND2410005-01 offers Disease Management Program for Diabetes.
Does BlueCare 70 Gold Health Insurance Plan, Variant (37160ND2410005-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the BlueCare 70 Gold Health Insurance Plan Variant 37160ND2410005-01 offers Disease Management Program for High blood pressure & high cholesterol.
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