Focused Silver - 53932AL0100005 Health Insurance Plan

Celtic Insurance Company health insurance plan with the Plan ID 53932AL0100005. The plan is called Focused Silver.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.15% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.85% of the costs of all covered benefits (according to the Issuer).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.21% (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 29.79% 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 53932AL0100005
Health Insurance Plan Year 2023
State Alabama
Health Insurance Issuer Celtic Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 53932AL0100005-01
Provider Network(s) ['ALN001']
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 Alabama 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 - 53932AL0100005-00

Standard On Exchange Plan - 53932AL0100005-01

Open to Indians below 300% FPL - 53932AL0100005-02

Open to Indians above 300% FPL - 53932AL0100005-03

73% AV Silver Plan - 53932AL0100005-04

87% AV Silver Plan - 53932AL0100005-05

94% AV Silver Plan - 53932AL0100005-06

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

Benefits of Focused Silver Health Insurance Plan, 53932AL0100005-01

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

$100.00

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

Covered under, Inpatient, Outpatient, and Physician Services.

YES

50.00% Coinsurance after deductible

100.00%
Chiropractic Care
YES

$90.00

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

50.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children
NO
Diabetes Education

Covered under disease management, which includes education.

YES

$100.00

100.00%
Dialysis
YES

50.00% Coinsurance after deductible

100.00%
Durable Medical Equipment

(1) artificial arms and other prosthetics, leg braces, and other orthopedic devices; (2) medical supplies such as oxygen, crutches, casts, catheters, colostomy bags and supplies, and splints.

YES

50.00% Coinsurance after deductible

100.00%
Emergency Room Services
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Eye Glasses for Children

Limit: 1.0 Visit(s) per Year

YES

No Charge

100.00%
Gender Affirming Care
YES

50.00% Coinsurance after deductible

100.00%
Generic Drugs
YES

$22.60

100.00%
Habilitation Services
YES

50.00% Coinsurance after deductible

100.00%
Hearing Aids
NO
Home Health Care Services
YES

50.00% Coinsurance after deductible

100.00%
Hospice Services
YES

50.00% Coinsurance after deductible

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

50.00% Coinsurance after deductible

100.00%
Infertility Treatment
NO
Infusion Therapy

Covered under the Home Health benefit.

YES

50.00% Coinsurance after deductible

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

50.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

50.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

$50.00

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

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Mental/Behavioral Health Emergency Transportation/Ambulance
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Mental/Behavioral Health ER Physician Fee
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services

Limit: 30.0 Days per Year

30 day limit when not coordinated by EPS provider.

YES

50.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Other Services
YES

50.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services

Limit: 20.0 Days per Year

If mental Health services provided through Expanded Psychiatric Service (EPS) provider, 30 days of outpatient care covered, if not through EPS 20 days.

YES

$45.00

100.00%
Mental/Behavioral Health Urgent Care
YES

$60.00

100.00%
Non-Preferred Brand Drugs
YES

50.00% Coinsurance after deductible

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

Billed as Primary Care Physician Office Visit.

YES

$45.00

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

50.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

While outpatient rehab is not mentioned, occupational, physical and speech therapy with combined limit (30 visits per year).

YES

50.00% Coinsurance after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

50.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs
YES

$75.00

100.00%
Prenatal and Postnatal Care
YES

$45.00

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

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

$45.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices

Artificial arms and other prosthetics, leg braces, and other orthopedic devices.

YES

50.00% Coinsurance after deductible

100.00%
Radiation

Covered under, Inpatient, Outpatient, and Physician Services.

YES

50.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Requires member and doctor to prove surgery is reconstructive, not cosmetic by providing medical and photographic evidence prior to and after surgery.

YES

50.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 30.0 Visit(s) per Year

YES

50.00% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 30.0 Visit(s) per Year

YES

50.00% Coinsurance after deductible

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

Limit: 1.0 Visit(s) per Year

YES

No Charge

100.00%
Routine Foot Care
NO
Skilled Nursing Facility
YES

50.00% Coinsurance after deductible

100.00%
Specialist Visit

One consult per specialist per day.

YES

$100.00

100.00%
Specialty Drugs

A drug included in the Specialty Drug List may also be considered a generic, preferred brand name, or other brand name drug. If a drug falls into multiple categories, the drug will be considered a specialty drug, and not a generic drug or other type of drug, as long as it remains on the Specialty Drug List.

YES

50.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services

Limit: 30.0 Days per Year

YES

50.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services

Limit: 20.0 Days per Year

If mental Health services provided through Expanded Psychiatric Service (EPS) provider, 30 days of outpatient care covered, if not through EPS 20 days.

YES

$45.00

100.00%
Substance Use Disorder Emergency Room
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Substance Use Disorder Emergency Transportation/Ambulance
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Substance Use Disorder ER Physician Fee
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Substance Use Disorder Outpatient Other Services
YES

50.00% Coinsurance after deductible

100.00%
Substance Use Disorder Urgent Care
YES

$60.00

100.00%
Transplant
YES

50.00% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders
NO
Urgent Care Centers or Facilities
YES

$60.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care

Limit: 9.0 Visit(s) per 2 Years

Well baby visits are covered for the child's first two years.

YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

50.00% Coinsurance after deductible

100.00%

Focused Silver Health Insurance Plan Variant 53932AL0100005-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.702111134
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 Silver On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID ALF005
Formulary URL URL
HIOS Product ID 53932AL010
Import Date 2/24/2023 1:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy Yes
Is a Referral Required for Specialist? No
Issuer Actuarial Value 70.15%
Issuer ID 53932
Issuer Marketplace Marketing Name Ambetter of Alabama
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID ALN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 53932AL0100005-01
Plan Marketing Name Focused Silver
Plan Type EPO
Plan Variant Marketing Name Focused Silver
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $800
SBC Scenario, Having a Baby, Copayment $600
SBC Scenario, Having a Baby, Deductible $6,100
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,800
SBC Scenario, Having Diabetes, Deductible $800
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ALS001
Source Name HIOS
Plan ID 53932AL0100005
State Code AL
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
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $12200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $6100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,100
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 $15000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $7500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,500
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 Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Focused Silver Health Insurance Plan, 53932AL0100005

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

Frequently Asked Questions(FAQ) about Focused Silver, 53932AL0100005 Health Insurance Plan, 53932AL0100005

  • Does Focused Silver Health Insurance Plan, 53932AL0100005 support Mail Ordering?

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

  • Does (53932AL0100005) Health Insurance Plan, Variant (53932AL0100005-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy

    Does (53932AL0100005) Health Insurance Plan, Variant (53932AL0100005-01) have Out Of Country Coverage?

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

    Does (53932AL0100005) Health Insurance Plan, Variant (53932AL0100005-01) 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 (53932AL0100005) Health Insurance Plan, Variant (53932AL0100005-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy

    Does Focused Silver Health Insurance Plan, Variant (53932AL0100005-01) offer Disease Management Programs for Asthma?

    Yes, the Focused Silver Health Insurance Plan Variant 53932AL0100005-01 offers Disease Management Program for Asthma.

    Does Focused Silver Health Insurance Plan, Variant (53932AL0100005-01) offer Disease Management Programs for Heart disease?

    Yes, the Focused Silver Health Insurance Plan Variant 53932AL0100005-01 offers Disease Management Program for Heart disease.

    Does Focused Silver Health Insurance Plan, Variant (53932AL0100005-01) offer Disease Management Programs for Diabetes?

    Yes, the Focused Silver Health Insurance Plan Variant 53932AL0100005-01 offers Disease Management Program for Diabetes.

    Does Focused Silver Health Insurance Plan, Variant (53932AL0100005-01) offer Disease Management Programs for Pregnancy?

    Yes, the Focused Silver Health Insurance Plan Variant 53932AL0100005-01 offers Disease Management Program for Pregnancy.

 

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