Constant Care Silver 1 + Vision - 52697WI0050002 Health Insurance Plan

Molina Healthcare of Wisconsin, Inc. health insurance plan with the Plan ID 52697WI0050002. The plan is called Constant Care Silver 1 + Vision.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.29% (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 29.71% 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 52697WI0050002
Health Insurance Plan Year 2022
State Wisconsin
Health Insurance Issuer Molina Healthcare of Wisconsin, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 52697WI0050002-00
Provider Network(s) ['WIN001']
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 Wisconsin 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 - 52697WI0050002-00

Standard On Exchange Plan - 52697WI0050002-01

Open to Indians below 300% FPL - 52697WI0050002-02

Open to Indians above 300% FPL - 52697WI0050002-03

73% AV Silver Plan - 52697WI0050002-04

87% AV Silver Plan - 52697WI0050002-05

94% AV Silver Plan - 52697WI0050002-06

Last Plan Update Date Sat, 14 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Constant Care Silver 1 + Vision Health Insurance Plan Variant 52697WI0050002-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.702896174
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 Silver Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group $1600 per group
Drug EHB Deductible, Combined In/Out of Network, Family Per Person $800 per person
Drug EHB Deductible, Combined In/Out of Network, Individual $800
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 40.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group $1600 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $800 per person
Drug EHB Deductible, In Network (Tier 1), Individual $800
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, Depression, Diabetes, High Blood Pressure & High Cholesterol
EHB Percent of Total Premium 0.99137504
First Tier Utilization 100%
Formulary ID WIF002
Formulary URL URL
HIOS Product ID 52697WI005
Import Date 8/14/2021 0:43
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 52697
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 0.00%
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 Silver
Multiple In Network Tiers No
National Network No
Network ID WIN001
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) 52697WI0050002-00
Plan Marketing Name Constant Care Silver 1 + Vision
Plan Type HMO
Plan Variant Marketing Name Constant Care Silver 1 + Vision
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 $1,600
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $1,800
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID WIS001
Source Name HIOS
Plan ID 52697WI0050002
State Code WI
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $17000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $8500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $8,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $17000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,500
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 + Vision Health Insurance Plan, 52697WI0050002

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

Frequently Asked Questions(FAQ) about Constant Care Silver 1 + Vision, 52697WI0050002 Health Insurance Plan, 52697WI0050002

  • Does Constant Care Silver 1 + Vision Health Insurance Plan, 52697WI0050002 support Mail Ordering?

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

  • Does (52697WI0050002) Health Insurance Plan, Variant (52697WI0050002-00) offer Disease Management Programs?

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

    Does (52697WI0050002) Health Insurance Plan, Variant (52697WI0050002-00) have Out Of Country Coverage?

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

    Does (52697WI0050002) Health Insurance Plan, Variant (52697WI0050002-00) 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 (52697WI0050002) Health Insurance Plan, Variant (52697WI0050002-00) 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 + Vision Health Insurance Plan, Variant (52697WI0050002-00) offer Disease Management Programs for Asthma?

    Yes, the Constant Care Silver 1 + Vision Health Insurance Plan Variant 52697WI0050002-00 offers Disease Management Program for Asthma.

    Does Constant Care Silver 1 + Vision Health Insurance Plan, Variant (52697WI0050002-00) offer Disease Management Programs for Heart disease?

    Yes, the Constant Care Silver 1 + Vision Health Insurance Plan Variant 52697WI0050002-00 offers Disease Management Program for Heart disease.

    Does Constant Care Silver 1 + Vision Health Insurance Plan, Variant (52697WI0050002-00) offer Disease Management Programs for Depression?

    Yes, the Constant Care Silver 1 + Vision Health Insurance Plan Variant 52697WI0050002-00 offers Disease Management Program for Depression.

    Does Constant Care Silver 1 + Vision Health Insurance Plan, Variant (52697WI0050002-00) offer Disease Management Programs for Diabetes?

    Yes, the Constant Care Silver 1 + Vision Health Insurance Plan Variant 52697WI0050002-00 offers Disease Management Program for Diabetes.

    Does Constant Care Silver 1 + Vision Health Insurance Plan, Variant (52697WI0050002-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Constant Care Silver 1 + Vision Health Insurance Plan Variant 52697WI0050002-00 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