Confident Care Gold 1 + Vision - 42326SC0020001 Health Insurance Plan

MOLINA HEALTHCARE OF SOUTH CAROLINA, INC health insurance plan with the Plan ID 42326SC0020001. The plan is called Confident Care Gold 1 + Vision.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 78.84% (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 21.16% 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 42326SC0020001
Health Insurance Plan Year 2022
State South Carolina
Health Insurance Issuer MOLINA HEALTHCARE OF SOUTH CAROLINA, INC
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 42326SC0020001-00
Provider Network(s) ['SCN001']
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 South Carolina 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 - 42326SC0020001-00

Standard On Exchange Plan - 42326SC0020001-01

Open to Indians below 300% FPL - 42326SC0020001-02

Open to Indians above 300% FPL - 42326SC0020001-03

Last Plan Update Date Fri, 13 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Confident Care Gold 1 + Vision Off Exchange Health Insurance Plan Variant 42326SC0020001-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.788365988
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 Gold Off Exchange Plan
Dental Only Plan No
EHB Percent of Total Premium 0.992161921
First Tier Utilization 100%
Formulary ID SCF001
Formulary URL URL
HIOS Product ID 42326SC002
Import Date 8/13/2021 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 42326
Issuer Marketplace Marketing Name Molina Healthcare
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID SCN001
Out of Country Coverage No
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) 42326SC0020001-00
Plan Marketing Name Confident Care Gold 1 + Vision
Plan Type HMO
Plan Variant Marketing Name Confident Care Gold 1 + Vision Off Exchange
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,900
SBC Scenario, Having a Baby, Copayment $300
SBC Scenario, Having a Baby, Deductible $2,100
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $600
SBC Scenario, Having Diabetes, Deductible $800
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $400
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,700
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID SCS001
Source Name HIOS
Plan ID 42326SC0020001
State Code SC
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $17100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $8550 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $8,550
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $4200 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $2100 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $2,100
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 $4200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $2100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $2,100
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 $17100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8550 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,550
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 Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of Confident Care Gold 1 + Vision Health Insurance Plan, 42326SC0020001

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

Frequently Asked Questions(FAQ) about Confident Care Gold 1 + Vision, 42326SC0020001 Health Insurance Plan, 42326SC0020001

  • Does Confident Care Gold 1 + Vision Health Insurance Plan, 42326SC0020001 support Mail Ordering?

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

  • Does (42326SC0020001) Health Insurance Plan, Variant (42326SC0020001-00) have Out Of Country Coverage?

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

    Does (42326SC0020001) Health Insurance Plan, Variant (42326SC0020001-00) 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: 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