CHP TX Silver LD - Two Free PCP Visits - 66252TX0050004 Health Insurance Plan

CHRISTUS Health Plan health insurance plan with the Plan ID 66252TX0050004. The plan is called CHP TX Silver LD - Two Free PCP Visits.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.63% (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 28.37% 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 66252TX0050004
Health Insurance Plan Year 2022
State Texas
Health Insurance Issuer CHRISTUS Health Plan
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 66252TX0050004-00
Provider Network(s) ['TXN001']
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 Texas 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 - 66252TX0050004-00

Standard On Exchange Plan - 66252TX0050004-01

Open to Indians below 300% FPL - 66252TX0050004-02

Open to Indians above 300% FPL - 66252TX0050004-03

73% AV Silver Plan - 66252TX0050004-04

87% AV Silver Plan - 66252TX0050004-05

94% AV Silver Plan - 66252TX0050004-06

Last Plan Update Date Wed, 18 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

CHP TX Silver LD - Two Free PCP Visits Health Insurance Plan Variant 66252TX0050004-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.716263401
Begin Primary Care Cost-Sharing After Number Of Visits 2
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 Silver Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Diabetes
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID TXF007
Formulary URL URL
HIOS Product ID 66252TX005
Import Date 8/18/2021 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 66252
Issuer Marketplace Marketing Name CHRISTUS Health Plan
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 TXN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 66252TX0050004-00
Plan Marketing Name CHP TX Silver LD - Two Free PCP Visits
Plan Type HMO
Plan Variant Marketing Name CHP TX Silver LD - Two Free PCP Visits
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $5,900
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $700
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $2,300
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $700
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $1,100
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $700
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID TXS004
Source Name HIOS
Plan ID 66252TX0050004
State Code TX
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $8,700
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $1400 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $700 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $700
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 $1400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $700 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $700
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $1400 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $700 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $700
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), Out of Network, Family Per Group $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $8,700
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of CHP TX Silver LD - Two Free PCP Visits Health Insurance Plan, 66252TX0050004

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

Frequently Asked Questions(FAQ) about CHP TX Silver LD - Two Free PCP Visits, 66252TX0050004 Health Insurance Plan, 66252TX0050004

  • Does CHP TX Silver LD - Two Free PCP Visits Health Insurance Plan, 66252TX0050004 support Mail Ordering?

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

  • Does (66252TX0050004) Health Insurance Plan, Variant (66252TX0050004-00) offer Disease Management Programs?

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

    Does (66252TX0050004) Health Insurance Plan, Variant (66252TX0050004-00) have Out Of Country Coverage?

    Yes. Details: Emergency Services

    Does (66252TX0050004) Health Insurance Plan, Variant (66252TX0050004-00) have Out of Service Area Coverage?

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

    Does (66252TX0050004) Health Insurance Plan, Variant (66252TX0050004-00) offer Disease Management Programs?

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

    Does CHP TX Silver LD - Two Free PCP Visits Health Insurance Plan, Variant (66252TX0050004-00) offer Disease Management Programs for Diabetes?

    Yes, the CHP TX Silver LD - Two Free PCP Visits Health Insurance Plan Variant 66252TX0050004-00 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