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CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Field Data
Health Insurance Plan ID50328WV0020021
Health Insurance Plan Year2022
StateWest Virginia
Health Insurance IssuerCareSource West Virginia Co.
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateThu, 12 Aug 2021 00:00 GMT
Last Import DateFri, 31 Mar 2023 05:06 GMT
Health Insurance Plan Variant50328WV0020021-04
 
Available Variants of the Health Plan

50328WV0020021-00

50328WV0020021-01

50328WV0020021-02

50328WV0020021-03

50328WV0020021-04

50328WV0020021-05

50328WV0020021-06

CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 Attributes

Plan Attribute Value
AV Calculator Output Number 0.723852119
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 73% AV Level Silver Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 0.988924051
First Tier Utilization 100%
Formulary ID WVF004
Formulary URLURL
HIOS Product ID 50328WV002
Import Date 8/13/2021 20:00
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 Yes
Is a Referral Required for Specialist? No
Issuer ID 50328
Issuer Marketplace Marketing Name CareSource
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID WVN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Services Only
Plan BrochureURL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 50328WV0020021-04
Plan Marketing Name CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness
Plan Type HMO
Plan Variant Marketing Name CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $500
SBC Scenario, Having a Baby, Deductible $5,700
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $400
SBC Scenario, Having Diabetes, Deductible $4,000
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID WVS001
Source Name SERFF
Plan ID 50328WV0020021
State Code WV
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $13200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $6600 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $6,600
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $11400 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $5700 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $5,700
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 20.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $11400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5700 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,700
TEHBDedOutOfNetFamilyPerGroup per group not applicable
TEHBDedOutOfNetFamilyPerPerson 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 $13200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6600 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,600
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 Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program Offered Yes

Copay & Coinsurance of CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness Health Insurance Plan, 50328WV0020021

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

Frequently Asked Questions(FAQ) about CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness, 50328WV0020021 Health Insurance Plan, 50328WV0020021

Does CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness Health Insurance Plan, 50328WV0020021 support Mail Ordering?

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

Does (50328WV0020021) Health Insurance Plan, Variant (50328WV0020021-04) 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

Does (50328WV0020021) Health Insurance Plan, Variant (50328WV0020021-04) have Out Of Country Coverage?

Yes. Details: Emergency Services Only

Does (50328WV0020021) Health Insurance Plan, Variant (50328WV0020021-04) have Out of Service Area Coverage?

Yes. Details: Emergency Services Only

Does (50328WV0020021) Health Insurance Plan, Variant (50328WV0020021-04) 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

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for Asthma?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for Asthma.

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for Heart disease?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for Heart disease.

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for Depression?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for Depression.

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for Diabetes?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for Diabetes.

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for High blood pressure & high cholesterol?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for High blood pressure & high cholesterol.

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for Low back pain?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for Low back pain.

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for Pain management?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for Pain management.

Does CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan, Variant (50328WV0020021-04) offer Disease Management Programs for Pregnancy?

Yes, the CareSource Marketplace Low Premium Silver 1 Dental, Vision, & Fitness Health Insurance Plan Variant 50328WV0020021-04 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Fri, 31 Mar 2023 05:06 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