Friday Bronze Copay + Vision Exam - 90617GA0010007 Health Insurance Plan

Friday Health Plans of Georgia Inc health insurance plan with the Plan ID 90617GA0010007. The plan is called Friday Bronze Copay + Vision Exam.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.20% (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 35.80% 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 90617GA0010007
Health Insurance Plan Year 2023
State Georgia
Health Insurance Issuer Friday Health Plans of Georgia Inc
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 90617GA0010007-00
Provider Network(s) ['GAN001']
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 Georgia 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 - 90617GA0010007-00

Standard On Exchange Plan - 90617GA0010007-01

Open to Indians below 300% FPL - 90617GA0010007-02

Open to Indians above 300% FPL - 90617GA0010007-03

Last Plan Update Date Wed, 21 Dec 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Friday Bronze Copay + Vision Exam Health Insurance Plan, 90617GA0010007-00

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

No Charge after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

No Charge after deductible

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

No Charge after deductible

100.00%
Chiropractic Care

Limited to 40 visits per plan year

YES

No Charge after deductible

100.00%
Cosmetic Surgery
YES

No Charge after deductible

100.00%
Delivery and All Inpatient Services for Maternity Care
YES

No Charge after deductible

100.00%
Dental Check-Up for Children

Limit: 2.0 Procedure(s) per Year

NO
Diabetes Education
YES

No Charge

100.00%
Dialysis
YES

No Charge after deductible

100.00%
Durable Medical Equipment
YES

No Charge after deductible

100.00%
Emergency Room Services
YES

No Charge after deductible

No Charge after deductible
Emergency Transportation/Ambulance
YES

No Charge after deductible

No Charge after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

No Charge

100.00%
Gender Affirming Care
YES

No Charge after deductible

100.00%
Generic Drugs

Value displayed reflects the maximum copay / co insurance amount a member could pay.

YES

$30.00

100.00%
Habilitation Services

Limit: 40.0 Visit(s) per Year

Limited to 40 PT/OT/ST Habilitation outpatient visits per therapy per plan year

YES

$150.00

100.00%
Hearing Aids

Limit of one hearing aid per year, every 48 months.

YES

No Charge after deductible

100.00%
Home Health Care Services

Limit: 120.0 Visit(s) per Year

YES

No Charge after deductible

100.00%
Hospice Services
YES

No Charge after deductible

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

No Charge after deductible

100.00%
Infertility Treatment
NO
Infusion Therapy

Insulin infusion devices.

YES

No Charge after deductible

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

No Charge after deductible

100.00%
Inpatient Physician and Surgical Services
YES

No Charge after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

No Charge after deductible

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

No Charge after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

No Charge

100.00%
Non-Preferred Brand Drugs

Value displayed reflects the maximum copay / co insurance amount a member could pay.

YES

No Charge after deductible

100.00%
Nutritional Counseling

Limit: 4.0 Visit(s) per Year

YES

$150.00

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

No Charge

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

No Charge after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 40.0 Visit(s) per Year

Limited to 40 PT/OY/ST rehabilitation visits per plan year

YES

$150.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

No Charge after deductible

100.00%
Preferred Brand Drugs

Value displayed reflects the maximum copay / co insurance amount a member could pay.

YES

$160.00

100.00%
Prenatal and Postnatal Care
YES

$150.00

100.00%
Preventive Care/Screening/Immunization

The recommendations by the USPSTF for breast cancer screenings, mammography and preventions issued prior to November 2009 will be considered current. Immunizations covered are those recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC).

YES

No Charge

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

No Charge

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

No Charge after deductible

100.00%
Radiation
YES

No Charge after deductible

100.00%
Reconstructive Surgery
YES

No Charge after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 40.0 Visit(s) per Year

Limited to 40 PT/OY/ST rehabilitation visits per plan year

YES

$150.00

100.00%
Rehabilitative Speech Therapy

Limit: 40.0 Visit(s) per Year

Limited to 40 PT/OY/ST rehabilitation visits per plan year

YES

$150.00

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

Limit: 1.0 Exam(s) per Year

YES

No Charge

100.00%
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Year

YES

No Charge

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 60.0 Days per Year

YES

No Charge after deductible

100.00%
Specialist Visit
YES

$150.00

100.00%
Specialty Drugs

Value displayed reflects the maximum copay / co insurance amount a member could pay.

YES

No Charge after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

No Charge after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

No Charge

100.00%
Transplant

Limit: 10000.0 Dollars per Procedure

Limited to a combined maximum of $10,000 per covered organ transplant.

YES

No Charge after deductible

100.00%
Treatment for Temporomandibular Joint Disorders
YES

No Charge after deductible

100.00%
Urgent Care Centers or Facilities
YES

$175.00

$175.00
Weight Loss Programs
YES

$150.00

100.00%
Well Baby Visits and Care

Care provided for birth through age 5.

YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

No Charge after deductible

100.00%

FRIDAY Bronze Copay + Vision Exam: Unlimited $0 Primary Care Visits, up to $30 Preferred Generic Rx, $0 Mental Health Counseling, $0 Vision Exam, Off-Exch. Health Insurance Plan Variant 90617GA0010007-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.642012622
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 No
CSR Variation Type Standard Bronze Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Diabetes, Weight Loss Programs
EHB Percent of Total Premium 0.9987
First Tier Utilization 100%
Formulary ID GAF004
Formulary URL URL
HIOS Product ID 90617GA001
Import Date 12/21/2022 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 90617
Issuer Marketplace Marketing Name Friday Health Plans
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID GAN001
Out of Country Coverage Yes
Out of Country Coverage Description Urgent and Emergent
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Urgent and Emergent
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 90617GA0010007-00
Plan Marketing Name Friday Bronze Copay + Vision Exam
Plan Type HMO
Plan Variant Marketing Name FRIDAY Bronze Copay + Vision Exam: Unlimited $0 Primary Care Visits, up to $30 Preferred Generic Rx, $0 Mental Health Counseling, $0 Vision Exam, Off-Exch.
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $9,100
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $400
SBC Scenario, Having Diabetes, Deductible $4,000
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $700
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID GAS001
Source Name HIOS
Plan ID 90617GA0010007
State Code GA
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $9,100
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $18200 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $9100 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $9,100
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $18200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $9100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,100
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 $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 Friday Bronze Copay + Vision Exam Health Insurance Plan, 90617GA0010007

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

Frequently Asked Questions(FAQ) about Friday Bronze Copay + Vision Exam, 90617GA0010007 Health Insurance Plan, 90617GA0010007

  • Does Friday Bronze Copay + Vision Exam Health Insurance Plan, 90617GA0010007 support Mail Ordering?

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

  • Does (90617GA0010007) Health Insurance Plan, Variant (90617GA0010007-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes, Weight Loss Programs

    Does (90617GA0010007) Health Insurance Plan, Variant (90617GA0010007-00) have Out Of Country Coverage?

    Yes. Details: Urgent and Emergent

    Does (90617GA0010007) Health Insurance Plan, Variant (90617GA0010007-00) have Out of Service Area Coverage?

    Yes. Details: Urgent and Emergent

    Does (90617GA0010007) Health Insurance Plan, Variant (90617GA0010007-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes, Weight Loss Programs

    Does FRIDAY Bronze Copay + Vision Exam: Unlimited $0 Primary Care Visits, up to $30 Preferred Generic Rx, $0 Mental Health Counseling, $0 Vision Exam, Off-Exch. Health Insurance Plan, Variant (90617GA0010007-00) offer Disease Management Programs for Diabetes?

    Yes, the FRIDAY Bronze Copay + Vision Exam: Unlimited $0 Primary Care Visits, up to $30 Preferred Generic Rx, $0 Mental Health Counseling, $0 Vision Exam, Off-Exch. Health Insurance Plan Variant 90617GA0010007-00 offers Disease Management Program for Diabetes.

    Does FRIDAY Bronze Copay + Vision Exam: Unlimited $0 Primary Care Visits, up to $30 Preferred Generic Rx, $0 Mental Health Counseling, $0 Vision Exam, Off-Exch. Health Insurance Plan, Variant (90617GA0010007-00) offer Disease Management Programs for Weight loss programs?

    Yes, the FRIDAY Bronze Copay + Vision Exam: Unlimited $0 Primary Care Visits, up to $30 Preferred Generic Rx, $0 Mental Health Counseling, $0 Vision Exam, Off-Exch. Health Insurance Plan Variant 90617GA0010007-00 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