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Alliance Bronze HDHP 6000 Legacy LHP - 77969OR5280018 Health Insurance Plan

Regence BlueCross BlueShield of Oregon health insurance plan with the Plan ID 77969OR5280018. The plan is called Alliance Bronze HDHP 6000 Legacy LHP.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.79% (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 35.21% 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 ID77969OR5280018
Health Insurance Plan Year2022
StateOregon
Health Insurance IssuerRegence BlueCross BlueShield of Oregon
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateFri, 06 Aug 2021 00:00 GMT
Last Import DateSun, 24 Sep 2023 09:34 GMT
Health Insurance Plan Variant77969OR5280018-00
 
Available Variants of the Health Plan

77969OR5280018-00

77969OR5280018-01

77969OR5280018-02

77969OR5280018-03

Alliance Bronze HDHP 6000 Legacy LHP Health Insurance Plan Variant 77969OR5280018-00 Attributes

Plan Attribute Value
AV Calculator Output Number0.64785657
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
EHB Percent of Total Premium 0.996
First Tier Utilization100%
Formulary IDORF002
Formulary URLURL
HIOS Product ID77969OR528
Import Date8/6/2021 20:00
Limited Cost Sharing Plan Variation - Estimated Advanced Payment$0.00
Inpatient Copayment Maximum Days0
HSA EligibleYes
New/Existing PlanExisting
Notice Required for PregnancyNo
Is a Referral Required for Specialist?No
Issuer ID77969
Issuer Marketplace Marketing NameRegence BlueCross BlueShield of Oregon
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelExpanded Bronze
Multiple In Network TiersNo
National NetworkNo
Network IDORN003
Out of Country CoverageNo
Out of Service Area CoverageNo
Plan BrochureURL
Plan Effective Date1/1/2022
Plan ID (Standard Component ID with Variant) 77969OR5280018-00
Plan Marketing NameAlliance Bronze HDHP 6000 Legacy LHP
Plan TypeEPO
Plan Variant Marketing NameAlliance Bronze HDHP 6000 Legacy LHP
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$1,000
SBC Scenario, Having a Baby, Copayment$0
SBC Scenario, Having a Baby, Deductible$6,000
SBC Scenario, Having a Baby, Limit$61
SBC Scenario, Having Diabetes, Coinsurance$1,250
SBC Scenario, Having Diabetes, Copayment$0
SBC Scenario, Having Diabetes, Deductible$2,029
SBC Scenario, Having Diabetes, Limit$178
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 IDORS003
Source NameSERFF
Plan ID77969OR5280018
State CodeOR
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$12000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$6000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$6,000
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$14000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person$7000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual$7,000
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 Alliance Bronze HDHP 6000 Legacy LHP Health Insurance Plan, 77969OR5280018

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

Frequently Asked Questions(FAQ) about Alliance Bronze HDHP 6000 Legacy LHP, 77969OR5280018 Health Insurance Plan, 77969OR5280018

Does Alliance Bronze HDHP 6000 Legacy LHP Health Insurance Plan, 77969OR5280018 support Mail Ordering?

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

Does (77969OR5280018) Health Insurance Plan, Variant (77969OR5280018-00) have Out Of Country Coverage?

No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

Does (77969OR5280018) Health Insurance Plan, Variant (77969OR5280018-00) have Out of Service Area Coverage?

No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

 

Disclaimer: This is based on the import(Date: Sun, 24 Sep 2023 09:34 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