| Field | Data |
|---|---|
| Health Insurance Plan ID | 40047MI0010007 |
| Health Insurance Plan Year | 2022 |
| State | Michigan |
| Health Insurance Issuer | Molina Healthcare of Michigan, Inc. |
| Plan Formulary Description URL | Formulary URL |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Tue, 24 Aug 2021 00:00 GMT |
| Last Import Date | Fri, 31 Mar 2023 05:06 GMT |
| Health Insurance Plan Variant | 40047MI0010007-03 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.660729205 |
| 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 | Limited Cost Sharing Plan Variation |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $2700 per group |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $1350 per person |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $1,350 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 40.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $2700 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $1350 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $1,350 |
| DEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| DEHBDedOutOfNetFamilyPerPerson | 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 | 1 |
| First Tier Utilization | 100% |
| Formulary ID | MIF004 |
| Formulary URL | URL |
| HIOS Product ID | 40047MI001 |
| Import Date | 8/17/2021 20:00 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 2 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 40047 |
| 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 | MIN001 |
| 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) | 40047MI0010007-03 |
| Plan Marketing Name | Constant Care Silver 7 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Constant Care Silver 7 LCS |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $1,600 |
| 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 | $1,500 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MIS001 |
| Source Name | SERFF |
| Plan ID | 40047MI0010007 |
| State Code | MI |
| 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 |
| 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 | No |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|---|---|---|---|---|---|
| Five preventive | 1 month in retail | $0 | No charge | 0% | No charge | YES |
| Five preventive | 3 month in mail | $0 | No charge | 0% | No charge | YES |
| Four specialty | 1 month in retail | $0 | 40.0% | After deductible | NO | |
| One preferred generic | 1 month in retail | $0 | 0% | YES | ||
| One preferred generic | 3 month in mail | $0 | 0% | YES | ||
| Three non preferred brand and generic | 1 month in retail | $0 | 40.0% | After deductible | YES | |
| Three non preferred brand and generic | 3 month in mail | $0 | 26.669999999999998% | After deductible | YES | |
| Two preferred brand | 1 month in retail | $0 | 0% | YES | ||
| Two preferred brand | 3 month in mail | $0 | 0% | YES |
Frequently Asked Questions(FAQ) about Constant Care Silver 7 250, 40047MI0010007 Health Insurance Plan, 40047MI0010007
Does Constant Care Silver 7 250 Health Insurance Plan, 40047MI0010007 support Mail Ordering?
Yes, Constant Care Silver 7 250 Health Insurance
Plan, 40047MI0010007 supports mail ordering for the next drug tiers: Five preventive, One preferred generic, Three non preferred brand and generic, Two preferred brand
Does (40047MI0010007) Health Insurance Plan, Variant (40047MI0010007-03) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol
Does (40047MI0010007) Health Insurance Plan, Variant (40047MI0010007-03) have Out Of Country Coverage?
No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).
Does (40047MI0010007) Health Insurance Plan, Variant (40047MI0010007-03) 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 (40047MI0010007) Health Insurance Plan, Variant (40047MI0010007-03) 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 7 LCS Health Insurance Plan, Variant (40047MI0010007-03) offer Disease Management Programs for Asthma?
Yes, the Constant Care Silver 7 LCS Health Insurance Plan Variant 40047MI0010007-03 offers Disease Management Program for Asthma.
Does Constant Care Silver 7 LCS Health Insurance Plan, Variant (40047MI0010007-03) offer Disease Management Programs for Heart disease?
Yes, the Constant Care Silver 7 LCS Health Insurance Plan Variant 40047MI0010007-03 offers Disease Management Program for Heart disease.
Does Constant Care Silver 7 LCS Health Insurance Plan, Variant (40047MI0010007-03) offer Disease Management Programs for Depression?
Yes, the Constant Care Silver 7 LCS Health Insurance Plan Variant 40047MI0010007-03 offers Disease Management Program for Depression.
Does Constant Care Silver 7 LCS Health Insurance Plan, Variant (40047MI0010007-03) offer Disease Management Programs for Diabetes?
Yes, the Constant Care Silver 7 LCS Health Insurance Plan Variant 40047MI0010007-03 offers Disease Management Program for Diabetes.
Does Constant Care Silver 7 LCS Health Insurance Plan, Variant (40047MI0010007-03) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Constant Care Silver 7 LCS Health Insurance Plan Variant 40047MI0010007-03 offers Disease Management Program for High blood pressure & high cholesterol.
Disclaimer: This is based on the import(Date: Fri, 31 Mar 2023 05:06 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