Constant Care Silver 1 - 79975MS0010002 Health Insurance Plan

Molina Healthcare of Mississippi, Inc health insurance plan with the Plan ID 79975MS0010002. The plan is called Constant Care Silver 1.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.34% (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 28.66% 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 79975MS0010002
Health Insurance Plan Year 2023
State Mississippi
Health Insurance Issuer Molina Healthcare of Mississippi, Inc
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 79975MS0010002-00
Provider Network(s) ['MSN001']
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 Mississippi 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 - 79975MS0010002-00

Standard On Exchange Plan - 79975MS0010002-01

Open to Indians below 300% FPL - 79975MS0010002-02

Open to Indians above 300% FPL - 79975MS0010002-03

73% AV Silver Plan - 79975MS0010002-04

87% AV Silver Plan - 79975MS0010002-05

94% AV Silver Plan - 79975MS0010002-06

Last Plan Update Date Fri, 24 Feb 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Constant Care Silver 1 Health Insurance Plan, 79975MS0010002-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
YES

50.00% Coinsurance after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

$30.00

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy

Must be medically necessary. Company may require a treatment plan, outlining the goals of therapy, mode of therapy, and duration of therapy, to be submitted by the provider prior to the initiation of treatment.

YES

50.00%

100.00%
Chiropractic Care

Limit: 20.0 Visit(s) per Year

YES

$30.00

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Separate cost-sharing may apply for professional services. Maximum two days of facility copayments per inpatient admission.

YES

$1,200.00

100.00%
Dental Check-Up for Children
NO
Diabetes Education

Limit: 1.0 Visit(s) per Year

YES

No Charge

100.00%
Dialysis
YES

$60.00

100.00%
Durable Medical Equipment
YES

50.00% Coinsurance after deductible

100.00%
Emergency Room Services
YES

$950.00

$950.00
Emergency Transportation/Ambulance
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Benefit Period

YES

No Charge

100.00%
Gender Affirming Care
NO
Generic Drugs

Limit: 30.0 Days per Month

Coverage is limited to a 30-day supply retail or 90-day supply mail order.

YES

$29.00

100.00%
Habilitation Services

Limit: 20.0 Visit(s) per Year

YES

$60.00

100.00%
Hearing Aids
NO
Home Health Care Services
YES

No Charge

100.00%
Hospice Services

Limit: 6.0 Months per Lifetime

YES

No Charge

100.00%
Imaging (CT/PET Scans, MRIs)
YES

50.00% Coinsurance after deductible

100.00%
Infertility Treatment
NO
Infusion Therapy
YES

50.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

$1200.00 Copay per Day

100.00%
Inpatient Physician and Surgical Services
YES

$60.00

100.00%
Laboratory Outpatient and Professional Services
YES

$60.00

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

$1200.00 Copay per Day

100.00%
Mental/Behavioral Health Outpatient Services
YES

$30.00

100.00%
Non-Preferred Brand Drugs

Limit: 30.0 Days per Month

Coverage is limited to a 30-day supply retail or 90-day supply mail order.

YES

50.00% Coinsurance after deductible

100.00%
Nutritional Counseling
YES

$30.00

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

$30.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

50.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 20.0 Visit(s) per Year

Limited to 20 combined physical and occupational therapy visits per year, 20 speech therapy visits per year, and 36 cardiac rehabilitation visits per year.

YES

$60.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

50.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs

Limit: 30.0 Days per Month

Coverage is limited to a 30-day supply retail or 90-day supply mail order.

YES

$60.00

100.00%
Prenatal and Postnatal Care
YES

No Charge

100.00%
Preventive Care/Screening/Immunization

Covered services must be included in Grade A and B Recommendations of the USPSTF and include all other preventive health services required by PPACA.

YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

$30.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

50.00% Coinsurance after deductible

100.00%
Radiation

Must be medically necessary. Company may require a treatment plan, outlining the goals of therapy, mode of therapy, and duration of therapy, to be submitted by the provider prior to the initiation of treatment.

YES

50.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Plan only outlines benefits for breast reconstruction. Must be medically necessary and related to mastectomy. 2 copay max

YES

$60.00

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 20.0 Days per Year

The 20 visit limit is combined for chiropractic services, occupational therapy, and physical therapy.

YES

$60.00

100.00%
Rehabilitative Speech Therapy

Limit: 20.0 Visit(s) per Year

Not covered for learning disabilities and development problems.

YES

$60.00

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Benefit Period

YES

No Charge

100.00%
Routine Foot Care

Limit: 1.0 Visit(s) per Year

Requires a Diabetes diagnosis.

YES

$30.00

100.00%
Skilled Nursing Facility

Limit: 30.0 Days per Year

YES

$1200.00 Copay per Day

100.00%
Specialist Visit
YES

$60.00

100.00%
Specialty Drugs

Limit: 30.0 Days per Month

YES

50.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

$1200.00 Copay per Day

100.00%
Substance Abuse Disorder Outpatient Services
YES

$30.00

100.00%
Transplant
YES

$60.00

100.00%
Treatment for Temporomandibular Joint Disorders
YES

50.00% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities
YES

$30.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

$95.00

100.00%

Constant Care Silver 1 250 Off Exchange Health Insurance Plan Variant 79975MS0010002-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.713354069
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered Yes
CSR Variation Type Standard Silver Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 50.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group $5000 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $2500 per person
Drug EHB Deductible, In Network (Tier 1), Individual $2,500
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
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID MSF002
Formulary URL URL
HIOS Product ID 79975MS001
Import Date 2/24/2023 1:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 2
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 79975
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 per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 50.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $5000 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $2500 per person
Medical EHB Deductible, In Network (Tier 1), Individual $2,500
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 Silver
Multiple In Network Tiers No
National Network No
Network ID MSN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 79975MS0010002-00
Plan Marketing Name Constant Care Silver 1
Plan Type HMO
Plan Variant Marketing Name Constant Care Silver 1 250 Off Exchange
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $2,100
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,400
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 $900
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,200
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MSS001
Source Name HIOS
Plan ID 79975MS0010002
State Code MS
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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 Constant Care Silver 1 Health Insurance Plan, 79975MS0010002

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

Frequently Asked Questions(FAQ) about Constant Care Silver 1, 79975MS0010002 Health Insurance Plan, 79975MS0010002

  • Does Constant Care Silver 1 Health Insurance Plan, 79975MS0010002 support Mail Ordering?

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

  • Does (79975MS0010002) Health Insurance Plan, Variant (79975MS0010002-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol

    Does (79975MS0010002) Health Insurance Plan, Variant (79975MS0010002-00) have Out Of Country Coverage?

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

    Does (79975MS0010002) Health Insurance Plan, Variant (79975MS0010002-00) 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 (79975MS0010002) Health Insurance Plan, Variant (79975MS0010002-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol

    Does Constant Care Silver 1 250 Off Exchange Health Insurance Plan, Variant (79975MS0010002-00) offer Disease Management Programs for Asthma?

    Yes, the Constant Care Silver 1 250 Off Exchange Health Insurance Plan Variant 79975MS0010002-00 offers Disease Management Program for Asthma.

    Does Constant Care Silver 1 250 Off Exchange Health Insurance Plan, Variant (79975MS0010002-00) offer Disease Management Programs for Heart disease?

    Yes, the Constant Care Silver 1 250 Off Exchange Health Insurance Plan Variant 79975MS0010002-00 offers Disease Management Program for Heart disease.

    Does Constant Care Silver 1 250 Off Exchange Health Insurance Plan, Variant (79975MS0010002-00) offer Disease Management Programs for Depression?

    Yes, the Constant Care Silver 1 250 Off Exchange Health Insurance Plan Variant 79975MS0010002-00 offers Disease Management Program for Depression.

    Does Constant Care Silver 1 250 Off Exchange Health Insurance Plan, Variant (79975MS0010002-00) offer Disease Management Programs for Diabetes?

    Yes, the Constant Care Silver 1 250 Off Exchange Health Insurance Plan Variant 79975MS0010002-00 offers Disease Management Program for Diabetes.

    Does Constant Care Silver 1 250 Off Exchange Health Insurance Plan, Variant (79975MS0010002-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Constant Care Silver 1 250 Off Exchange Health Insurance Plan Variant 79975MS0010002-00 offers Disease Management Program for High blood pressure & high cholesterol.

 

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