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Bronze Classic- $3000 Ded - 23552TN0020023 Health Insurance Plan

Oscar Insurance Company health insurance plan with the Plan ID 23552TN0020023. The plan is called Bronze Classic- $3000 Ded.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.97% (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 35.03% 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 ID23552TN0020023
Health Insurance Plan Year2022
StateTennessee
Health Insurance IssuerOscar Insurance Company
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateWed, 02 Mar 2022 00:00 GMT
Last Import DateSun, 01 Oct 2023 10:53 GMT
Health Insurance Plan Variant23552TN0020023-00
 
Available Variants of the Health Plan

23552TN0020023-00

23552TN0020023-01

23552TN0020023-02

23552TN0020023-03

Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 Attributes

Plan Attribute Value
AV Calculator Output Number0.649712607
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 Bronze Off Exchange Plan
Dental Only PlanNo
Disease Management Programs OfferedAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1
First Tier Utilization20%
Formulary IDTNF001
Formulary URLURL
HIOS Product ID23552TN002
Import Date3/2/2022 1:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment$0.00
Inpatient Copayment Maximum Days0
HSA EligibleNo
New/Existing PlanNew
Notice Required for PregnancyNo
Is a Referral Required for Specialist?No
Issuer ID23552
Issuer Marketplace Marketing NameOscar Insurance Company
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelExpanded Bronze
Multiple In Network TiersYes
National NetworkNo
Network IDTNN001
Out of Country CoverageYes
Out of Country Coverage DescriptionEmergency Services only.
Out of Service Area CoverageYes
Out of Service Area Coverage DescriptionEmergency and Urgent Services only.
Plan BrochureURL
Plan Effective Date1/1/2022
Plan Expiration Date12/31/2022
Plan ID (Standard Component ID with Variant) 23552TN0020023-00
Plan Marketing NameBronze Classic- $3000 Ded
Plan TypeEPO
Plan Variant Marketing NameBronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care)
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$3,500
SBC Scenario, Having a Baby, Copayment$400
SBC Scenario, Having a Baby, Deductible$3,000
SBC Scenario, Having a Baby, Limit$50
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$1,800
SBC Scenario, Having Diabetes, Deductible$3,000
SBC Scenario, Having Diabetes, Limit$20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance$0
SBC Scenario, Treatment of a Simple Fracture, Copayment$2,100
SBC Scenario, Treatment of a Simple Fracture, Deductible$200
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Second Tier Utilization80%
Service Area IDTNS001
Source NameHIOS
Plan ID23552TN0020023
State CodeTN
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 Coinsurance50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group$6000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$3000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$3,000
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group$6000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person$3000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual$3,000
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), In Network (Tier 2), Family Per Group$17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person$8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), 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 Bronze Classic- $3000 Ded Health Insurance Plan, 23552TN0020023

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

Frequently Asked Questions(FAQ) about Bronze Classic- $3000 Ded, 23552TN0020023 Health Insurance Plan, 23552TN0020023

Does Bronze Classic- $3000 Ded Health Insurance Plan, 23552TN0020023 support Mail Ordering?

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

Does (23552TN0020023) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs?

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

Does (23552TN0020023) Health Insurance Plan, Variant (23552TN0020023-00) have Out Of Country Coverage?

Yes. Details: Emergency Services only.

Does (23552TN0020023) Health Insurance Plan, Variant (23552TN0020023-00) have Out of Service Area Coverage?

Yes. Details: Emergency and Urgent Services only.

Does (23552TN0020023) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs?

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

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Asthma?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Asthma.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Heart disease?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Heart disease.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Depression?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Depression.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Diabetes?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Diabetes.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for High blood pressure & high cholesterol?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for High blood pressure & high cholesterol.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Low back pain?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Low back pain.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Pain management?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Pain management.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Pregnancy?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Pregnancy.

Does Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan, Variant (23552TN0020023-00) offer Disease Management Programs for Weight loss programs?

Yes, the Bronze Classic- $3000 Ded ($3 Drugs + $0 Virtual Care) Health Insurance Plan Variant 23552TN0020023-00 offers Disease Management Program for Weight loss programs.

 

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