| Field | Data |
|---|---|
| Health Insurance Plan ID | 42261UT0060020 |
| Health Insurance Plan Year | 2023 |
| State | Utah |
| Health Insurance Issuer | University of Utah Health Insurance Plans |
| Plan Formulary Description URL | Formulary URL |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Wed, 17 Aug 2022 00:00 GMT |
| Last Import Date | Sun, 01 Oct 2023 10:53 GMT |
| Health Insurance Plan Variant | 42261UT0060020-02 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 1 |
| 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 | Zero Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Design 1 |
| 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 | 8/17/2022 20:01 |
| 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 | No |
| Is a Referral Required for Specialist? | No |
| 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 | Silver |
| 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 | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 42261UT0060020-02 |
| Plan Level Exclusions | See Plan Document |
| Plan Marketing Name | Healthy Premier Silver Standard |
| Plan Type | EPO |
| Plan Variant Marketing Name | Healthy Premier Silver Standard |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $50 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| 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 | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | UTS002 |
| Source Name | SERFF |
| Plan ID | 42261UT0060020 |
| State Code | UT |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $0 |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | $0 |
| 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 | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| TEHBDedOutOfNetFamilyPerGroup | $0 per group |
| TEHBDedOutOfNetFamilyPerPerson | $0 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $0 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | Yes |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Healthy Premier Silver Standard, 42261UT0060020 Health Insurance Plan, 42261UT0060020
Does Healthy Premier Silver Standard Health Insurance Plan, 42261UT0060020 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (42261UT0060020) Health Insurance Plan, Variant (42261UT0060020-02) 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 (42261UT0060020) Health Insurance Plan, Variant (42261UT0060020-02) 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 (42261UT0060020) Health Insurance Plan, Variant (42261UT0060020-02) 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 (42261UT0060020) Health Insurance Plan, Variant (42261UT0060020-02) 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 Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Asthma?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Asthma.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Heart disease?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Heart disease.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Depression?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Depression.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Diabetes?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Diabetes.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for High blood pressure & high cholesterol.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Low back pain?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Low back pain.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Pain management?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Pain management.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Pregnancy?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Pregnancy.
Does Healthy Premier Silver Standard Health Insurance Plan, Variant (42261UT0060020-02) offer Disease Management Programs for Weight loss programs?
Yes, the Healthy Premier Silver Standard Health Insurance Plan Variant 42261UT0060020-02 offers Disease Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Sun, 01 Oct 2023 10:53 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