Bronze B07S HSA + Free Preventive Care - 14002TN0400013 Health Insurance Plan

BlueCross BlueShield of Tennessee health insurance plan with the Plan ID 14002TN0400013. The plan is called Bronze B07S HSA + Free Preventive Care.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.92% (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 35.08% 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 14002TN0400013
Health Insurance Plan Year 2022
State Tennessee
Health Insurance Issuer BlueCross BlueShield of Tennessee
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 14002TN0400013-00
Provider Network(s) ['TNN002']
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 Tennessee 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 - 14002TN0400013-00

Standard On Exchange Plan - 14002TN0400013-01

Open to Indians below 300% FPL - 14002TN0400013-02

Open to Indians above 300% FPL - 14002TN0400013-03

Last Plan Update Date Sat, 14 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Bronze B07S HSA + Free Preventive Care Health Insurance Plan Variant 14002TN0400013-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.649249513
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 Bronze Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Diabetes
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID TNF001
Formulary URL URL
HIOS Product ID 14002TN040
Import Date 8/14/2021 0:43
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible Yes
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 14002
Issuer Marketplace Marketing Name BlueCross BlueShield of Tennessee
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network Yes
Network ID TNN002
Out of Country Coverage Yes
Out of Country Coverage Description Blue Cross Blue Shield Global Core
Out of Service Area Coverage Yes
Out of Service Area Coverage Description BlueCard PPO
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 14002TN0400013-00
Plan Marketing Name Bronze B07S HSA + Free Preventive Care
Plan Type EPO
Plan Variant Marketing Name Bronze B07S HSA + Free Preventive Care
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,000
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $5,950
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,600
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID TNS004
Source Name HIOS
Plan ID 14002TN0400013
State Code TN
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 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $11900 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5950 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,950
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 $13800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6900 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,900
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 Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Bronze B07S HSA + Free Preventive Care Health Insurance Plan, 14002TN0400013

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

Frequently Asked Questions(FAQ) about Bronze B07S HSA + Free Preventive Care, 14002TN0400013 Health Insurance Plan, 14002TN0400013

  • Does Bronze B07S HSA + Free Preventive Care Health Insurance Plan, 14002TN0400013 support Mail Ordering?

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

  • Does (14002TN0400013) Health Insurance Plan, Variant (14002TN0400013-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes

    Does (14002TN0400013) Health Insurance Plan, Variant (14002TN0400013-00) have Out Of Country Coverage?

    Yes. Details: Blue Cross Blue Shield Global Core

    Does (14002TN0400013) Health Insurance Plan, Variant (14002TN0400013-00) have Out of Service Area Coverage?

    Yes. Details: BlueCard PPO

    Does (14002TN0400013) Health Insurance Plan, Variant (14002TN0400013-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes

    Does Bronze B07S HSA + Free Preventive Care Health Insurance Plan, Variant (14002TN0400013-00) offer Disease Management Programs for Asthma?

    Yes, the Bronze B07S HSA + Free Preventive Care Health Insurance Plan Variant 14002TN0400013-00 offers Disease Management Program for Asthma.

    Does Bronze B07S HSA + Free Preventive Care Health Insurance Plan, Variant (14002TN0400013-00) offer Disease Management Programs for Heart disease?

    Yes, the Bronze B07S HSA + Free Preventive Care Health Insurance Plan Variant 14002TN0400013-00 offers Disease Management Program for Heart disease.

    Does Bronze B07S HSA + Free Preventive Care Health Insurance Plan, Variant (14002TN0400013-00) offer Disease Management Programs for Diabetes?

    Yes, the Bronze B07S HSA + Free Preventive Care Health Insurance Plan Variant 14002TN0400013-00 offers Disease Management Program for Diabetes.

 

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