BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) - 16842FL0120086 Health Insurance Plan

Blue Cross and Blue Shield of Florida health insurance plan with the Plan ID 16842FL0120086. The plan is called BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 81.48% (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 18.52% 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 16842FL0120086
Health Insurance Plan Year 2022
State Florida
Health Insurance Issuer Blue Cross and Blue Shield of Florida
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 16842FL0120086-00
Provider Network(s) ['FLN002']
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 Florida 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 - 16842FL0120086-00

Standard On Exchange Plan - 16842FL0120086-01

Open to Indians below 300% FPL - 16842FL0120086-02

Open to Indians above 300% FPL - 16842FL0120086-03

Last Plan Update Date Fri, 05 Nov 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 16842FL0120086-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.81477398
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 Gold 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 per person not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 20.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Drug EHB Deductible, In Network (Tier 1), Individual $0
Drug EHB Deductible, In Network (Tier 2), Default Coinsurance 20.00%
Drug EHB Deductible, In Network (Tier 2), Family Per Group $0 per group
Drug EHB Deductible, In Network (Tier 2), Family Per Person $0 per person
Drug EHB Deductible, In Network (Tier 2), Individual $0
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 1.54%
Formulary ID FLF025
Formulary URL URL
HIOS Product ID 16842FL012
Import Date 11/5/2021 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 16842
Issuer Marketplace Marketing Name Florida Blue (BlueCross BlueShield FL)
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 20.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $3000 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $1500 per person
Medical EHB Deductible, In Network (Tier 1), Individual $1,500
Medical EHB Deductible, In Network (Tier 2), Default Coinsurance 20.00%
Medical EHB Deductible, In Network (Tier 2), Family Per Group $3000 per group
Medical EHB Deductible, In Network (Tier 2), Family Per Person $1500 per person
Medical EHB Deductible, In Network (Tier 2), Individual $1,500
Medical EHB Deductible, Out of Network, Family Per Group $6000 per group
Medical EHB Deductible, Out of Network, Family Per Person $3000 per person
Medical EHB Deductible, Out of Network, Individual $3,000
Metal Level Gold
Multiple In Network Tiers Yes
National Network Yes
Network ID FLN002
Out of Country Coverage Yes
Out of Country Coverage Description Covered services as outlined in the member contract.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Covered services as outlined in the member contract.
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 16842FL0120086-00
Plan Marketing Name BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$)
Plan Type EPO
Plan Variant Marketing Name BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,100
SBC Scenario, Having a Baby, Copayment $90
SBC Scenario, Having a Baby, Deductible $1,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $2,100
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $30
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $700
SBC Scenario, Treatment of a Simple Fracture, Deductible $900
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 98.46%
Service Area ID FLS002
Source Name HIOS
Plan ID 16842FL0120086
State Code FL
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 $11000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $5500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $5,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group $11000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person $5500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $5,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $25000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $12500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $12,500
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, 16842FL0120086

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

Frequently Asked Questions(FAQ) about BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$), 16842FL0120086 Health Insurance Plan, 16842FL0120086

  • Does BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, 16842FL0120086 support Mail Ordering?

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

  • Does (16842FL0120086) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs?

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

    Does (16842FL0120086) Health Insurance Plan, Variant (16842FL0120086-00) have Out Of Country Coverage?

    Yes. Details: Covered services as outlined in the member contract.

    Does (16842FL0120086) Health Insurance Plan, Variant (16842FL0120086-00) have Out of Service Area Coverage?

    Yes. Details: Covered services as outlined in the member contract.

    Does (16842FL0120086) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs?

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

    Does BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs for Asthma?

    Yes, the BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 16842FL0120086-00 offers Disease Management Program for Asthma.

    Does BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs for Heart disease?

    Yes, the BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 16842FL0120086-00 offers Disease Management Program for Heart disease.

    Does BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs for Depression?

    Yes, the BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 16842FL0120086-00 offers Disease Management Program for Depression.

    Does BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs for Diabetes?

    Yes, the BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 16842FL0120086-00 offers Disease Management Program for Diabetes.

    Does BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 16842FL0120086-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (16842FL0120086-00) offer Disease Management Programs for Pregnancy?

    Yes, the BlueSelect Gold 1835 ($0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 16842FL0120086-00 offers Disease Management Program for Pregnancy.

 

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