Molina Gold 3 - 45786TX0010001 Health Insurance Plan

Molina Healthcare of Texas, Inc. health insurance plan with the Plan ID 45786TX0010001. The plan is called Molina Gold 3.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 80.94% (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 19.06% 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 45786TX0010001
Health Insurance Plan Year 2022
State Texas
Health Insurance Issuer Molina Healthcare of Texas, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 45786TX0010001-00
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 - 45786TX0010001-00

Standard On Exchange Plan - 45786TX0010001-01

Open to Indians below 300% FPL - 45786TX0010001-02

Open to Indians above 300% FPL - 45786TX0010001-03

Last Plan Update Date Fri, 20 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Molina Gold 3 Off Exchange Health Insurance Plan Variant 45786TX0010001-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.809410444
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
Drug EHB Deductible, Combined In/Out of Network, Family Per Group $0 per group
Drug EHB Deductible, Combined In/Out of Network, Family Per Person $0 per person
Drug EHB Deductible, Combined In/Out of Network, Individual $0
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 30.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Drug EHB Deductible, In Network (Tier 1), Individual $0
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID TXF001
Formulary URL URL
HIOS Product ID 45786TX001
Import Date 8/20/2021 1:03
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 45786
Issuer Marketplace Marketing Name Molina Healthcare
Market Coverage Individual
Medical Drug Deductibles Integrated No
Medical Drug Maximum Out of Pocket Integrated Yes
Medical EHB Deductible, Combined In/Out of Network, Family Per Group $0 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person $0 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $0
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 20.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Medical EHB Deductible, In Network (Tier 1), Individual $0
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Out of Network, Individual Not Applicable
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID TXN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergent is Covered
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergenct is Covered
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 45786TX0010001-00
Plan Marketing Name Molina Gold 3
Plan Type HMO
Plan Variant Marketing Name Molina Gold 3 Off Exchange
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,200
SBC Scenario, Having a Baby, Copayment $600
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $200
SBC Scenario, Having Diabetes, Copayment $1,600
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $500
SBC Scenario, Treatment of a Simple Fracture, Copayment $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID TXS001
Source Name HIOS
Plan ID 45786TX0010001
State Code TX
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $16300 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $8150 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $8,150
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $16300 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8150 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,150
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 Molina Gold 3 Health Insurance Plan, 45786TX0010001

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

Frequently Asked Questions(FAQ) about Molina Gold 3, 45786TX0010001 Health Insurance Plan, 45786TX0010001

  • Does Molina Gold 3 Health Insurance Plan, 45786TX0010001 support Mail Ordering?

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

  • Does (45786TX0010001) Health Insurance Plan, Variant (45786TX0010001-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs

    Does (45786TX0010001) Health Insurance Plan, Variant (45786TX0010001-00) have Out Of Country Coverage?

    Yes. Details: Emergent is Covered

    Does (45786TX0010001) Health Insurance Plan, Variant (45786TX0010001-00) have Out of Service Area Coverage?

    Yes. Details: Emergenct is Covered

    Does (45786TX0010001) Health Insurance Plan, Variant (45786TX0010001-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy, Weight Loss Programs

    Does Molina Gold 3 Off Exchange Health Insurance Plan, Variant (45786TX0010001-00) offer Disease Management Programs for Asthma?

    Yes, the Molina Gold 3 Off Exchange Health Insurance Plan Variant 45786TX0010001-00 offers Disease Management Program for Asthma.

    Does Molina Gold 3 Off Exchange Health Insurance Plan, Variant (45786TX0010001-00) offer Disease Management Programs for Heart disease?

    Yes, the Molina Gold 3 Off Exchange Health Insurance Plan Variant 45786TX0010001-00 offers Disease Management Program for Heart disease.

    Does Molina Gold 3 Off Exchange Health Insurance Plan, Variant (45786TX0010001-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Molina Gold 3 Off Exchange Health Insurance Plan Variant 45786TX0010001-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Molina Gold 3 Off Exchange Health Insurance Plan, Variant (45786TX0010001-00) offer Disease Management Programs for Pregnancy?

    Yes, the Molina Gold 3 Off Exchange Health Insurance Plan Variant 45786TX0010001-00 offers Disease Management Program for Pregnancy.

    Does Molina Gold 3 Off Exchange Health Insurance Plan, Variant (45786TX0010001-00) offer Disease Management Programs for Weight loss programs?

    Yes, the Molina Gold 3 Off Exchange Health Insurance Plan Variant 45786TX0010001-00 offers Disease Management Program for Weight loss programs.

 

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