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BlueEssentials Silver 7 - 26065SC0380015 Health Insurance Plan

Blue Cross and Blue Shield of South Carolina health insurance plan with the Plan ID 26065SC0380015. The plan is called BlueEssentials Silver 7.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 66.50% (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 33.50% 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 ID26065SC0380015
Health Insurance Plan Year2022
StateSouth Carolina
Health Insurance IssuerBlue Cross and Blue Shield of South Carolina
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateThu, 02 Dec 2021 00:00 GMT
Last Import DateSun, 01 Oct 2023 10:53 GMT
Health Insurance Plan Variant26065SC0380015-00
 
Available Variants of the Health Plan

26065SC0380015-00

26065SC0380015-01

26065SC0380015-02

26065SC0380015-03

26065SC0380015-04

26065SC0380015-05

26065SC0380015-06

BlueEssentials Silver 7 Health Insurance Plan Variant 26065SC0380015-00 Attributes

Plan Attribute Value
AV Calculator Output Number0.664972603
Begin Primary Care Cost-Sharing After Number Of Visits0
Begin Primary Care Deductible Coinsurance After Number Of Copays0
Business Year2022
Child-Only OfferingAllows Adult and Child-Only
Composite Rating OfferedNo
CSR Variation TypeStandard Silver Off Exchange Plan
Dental Only PlanNo
EHB Percent of Total Premium 1
First Tier Utilization100%
Formulary IDSCF007
Formulary URLURL
HIOS Product ID26065SC038
Import Date12/2/2021 1:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment$0.00
Inpatient Copayment Maximum Days0
HSA EligibleNo
New/Existing PlanExisting
Notice Required for PregnancyNo
Is a Referral Required for Specialist?No
Issuer ID26065
Issuer Marketplace Marketing NameBlueCross BlueShield of South Carolina
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelSilver
Multiple In Network TiersNo
National NetworkNo
Network IDSCN001
Out of Country CoverageNo
Out of Country Coverage DescriptionBenefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.
Out of Service Area CoverageNo
Out of Service Area Coverage DescriptionBenefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.
Plan Effective Date1/1/2022
Plan Expiration Date12/31/2022
Plan ID (Standard Component ID with Variant) 26065SC0380015-00
Plan Marketing NameBlueEssentials Silver 7
Plan TypeEPO
Plan Variant Marketing NameBlueEssentials Silver 7
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$1,300
SBC Scenario, Having a Baby, Copayment$10
SBC Scenario, Having a Baby, Deductible$7,400
SBC Scenario, Having a Baby, Limit$60
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$2,500
SBC Scenario, Having Diabetes, Deductible$900
SBC Scenario, Having Diabetes, Limit$20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance$0
SBC Scenario, Treatment of a Simple Fracture, Copayment$200
SBC Scenario, Treatment of a Simple Fracture, Deductible$2,500
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Service Area IDSCS001
Source NameHIOS
Plan ID26065SC0380015
State CodeSC
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Personper person 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, Family Per Groupper group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Personper person 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 Coinsurance25.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group$14800 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$7400 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$7,400
TEHBDedOutOfNetFamilyPerGroupper group not applicable
TEHBDedOutOfNetFamilyPerPersonper person 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 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 Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, IndividualNot Applicable
Unique Plan DesignNo
URL for Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program OfferedNo

Copay & Coinsurance of BlueEssentials Silver 7 Health Insurance Plan, 26065SC0380015

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

Frequently Asked Questions(FAQ) about BlueEssentials Silver 7, 26065SC0380015 Health Insurance Plan, 26065SC0380015

Does BlueEssentials Silver 7 Health Insurance Plan, 26065SC0380015 support Mail Ordering?

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

Does (26065SC0380015) Health Insurance Plan, Variant (26065SC0380015-00) have Out Of Country Coverage?

No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan). Details: Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.

Does (26065SC0380015) Health Insurance Plan, Variant (26065SC0380015-00) have Out of Service Area Coverage?

No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan). Details: Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.

 

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