Healthy Premier Bronze HSA - 42261UT0060003 Health Insurance Plan

University of Utah Health Insurance Plans health insurance plan with the Plan ID 42261UT0060003. The plan is called Healthy Premier Bronze HSA.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.87% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.13% 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 64.60% (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 35.40% 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 42261UT0060003
Health Insurance Plan Year 2022
State Utah
Health Insurance Issuer University of Utah Health Insurance Plans
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 42261UT0060003-00
Provider Network(s) ['UTN001']
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 Utah 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 - 42261UT0060003-00

Standard On Exchange Plan - 42261UT0060003-01

Open to Indians below 300% FPL - 42261UT0060003-02

Open to Indians above 300% FPL - 42261UT0060003-03

Last Plan Update Date Wed, 18 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.6459965
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 Bronze Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID UTF004
Formulary URL URL
HIOS Product ID 42261UT006
Import Date 8/18/2021 20:00
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible Yes
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 64.87%
Issuer ID 42261
Issuer Marketplace Marketing Name University of Utah 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 UTN001
Out of Country Coverage No
Out of Country Coverage Description Emergent Only
Out of Service Area Coverage No
Out of Service Area Coverage Description Emergent Only
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 42261UT0060003-00
Plan Level Exclusions See Plan Document
Plan Marketing Name Healthy Premier Bronze HSA
Plan Type EPO
Plan Variant Marketing Name Healthy Premier Bronze HSA
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $7,000
SBC Scenario, Having a Baby, Limit $50
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $1,300
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID UTS001
Source Name SERFF
Plan ID 42261UT0060003
State Code UT
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $14000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $7000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $7,000
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $14000 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $7000 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $7,000
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 $14000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $7000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $7,000
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 $14000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $7000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,000
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 Yes

Copay & Coinsurance of Healthy Premier Bronze HSA Health Insurance Plan, 42261UT0060003

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

Frequently Asked Questions(FAQ) about Healthy Premier Bronze HSA, 42261UT0060003 Health Insurance Plan, 42261UT0060003

  • Does Healthy Premier Bronze HSA Health Insurance Plan, 42261UT0060003 support Mail Ordering?

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

  • Does (42261UT0060003) Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does (42261UT0060003) Health Insurance Plan, Variant (42261UT0060003-00) have Out Of Country Coverage?

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

    Does (42261UT0060003) Health Insurance Plan, Variant (42261UT0060003-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan). Details: Emergent Only

    Does (42261UT0060003) Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for Asthma?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 offers Disease Management Program for Asthma.

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for Heart disease?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 offers Disease Management Program for Heart disease.

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for Depression?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 offers Disease Management Program for Depression.

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for Diabetes?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 offers Disease Management Program for Diabetes.

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for Low back pain?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 offers Disease Management Program for Low back pain.

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for Pregnancy?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 offers Disease Management Program for Pregnancy.

    Does Healthy Premier Bronze HSA Health Insurance Plan, Variant (42261UT0060003-00) offer Disease Management Programs for Weight loss programs?

    Yes, the Healthy Premier Bronze HSA Health Insurance Plan Variant 42261UT0060003-00 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