HMO Catastrophic 8700 with 3 Free PCP visits - 86584WI0010008 Health Insurance Plan
Aspirus Health Plan, Inc. health insurance plan with the Plan ID 86584WI0010008. The plan is called HMO Catastrophic 8700 with 3 Free PCP visits.
| Health Insurance Plan ID | 86584WI0010008 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Wisconsin | ||||||||||||||||||
| Health Insurance Issuer | Aspirus Health Plan, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 86584WI0010008-00 | ||||||||||||||||||
| Provider Network(s) | ['WIN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Sat, 18 Dec 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan Variant 86584WI0010008-00 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 3 |
| 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 Catastrophic Off Exchange Plan |
| 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 | WIF001 |
| Formulary URL | URL |
| HIOS Product ID | 86584WI001 |
| Import Date | 12/18/2021 3:20 |
| 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 | 86584 |
| Issuer Marketplace Marketing Name | Aspirus Health Plan |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Catastrophic |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | WIN001 |
| Out of Country Coverage | No |
| Out of Country Coverage Description | Limited to emergency care only. |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | Limited to emergency care only. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 86584WI0010008-00 |
| Plan Marketing Name | HMO Catastrophic 8700 with 3 Free PCP visits |
| Plan Type | HMO |
| Plan Variant Marketing Name | HMO Catastrophic 8700 with 3 Free PCP visits |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,700 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,400 |
| SBC Scenario, Having Diabetes, Limit | $30 |
| 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 | WIS001 |
| Source Name | HIOS |
| Plan ID | 86584WI0010008 |
| State Code | WI |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $17400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $8700 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,700 |
| 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 | $17400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8700 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,700 |
| 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 |
Copay & Coinsurance of HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan, 86584WI0010008
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about HMO Catastrophic 8700 with 3 Free PCP visits, 86584WI0010008 Health Insurance Plan, 86584WI0010008
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Does HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan, 86584WI0010008 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (86584WI0010008) Health Insurance Plan, Variant (86584WI0010008-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol
Does (86584WI0010008) Health Insurance Plan, Variant (86584WI0010008-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan). Details: Limited to emergency care only.
Does (86584WI0010008) Health Insurance Plan, Variant (86584WI0010008-00) 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: Limited to emergency care only.
Does (86584WI0010008) Health Insurance Plan, Variant (86584WI0010008-00) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol
Does HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan, Variant (86584WI0010008-00) offer Disease Management Programs for Asthma?
Yes, the HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan Variant
86584WI0010008-00 offers Disease
Management Program for Asthma.
Does HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan, Variant (86584WI0010008-00) offer Disease Management Programs for Heart disease?
Yes, the HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan Variant
86584WI0010008-00 offers Disease
Management Program for Heart disease.
Does HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan, Variant (86584WI0010008-00) offer Disease Management Programs for Depression?
Yes, the HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan Variant
86584WI0010008-00 offers Disease
Management Program for Depression.
Does HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan, Variant (86584WI0010008-00) offer Disease Management Programs for Diabetes?
Yes, the HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan Variant
86584WI0010008-00 offers Disease
Management Program for Diabetes.
Does HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan, Variant (86584WI0010008-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the HMO Catastrophic 8700 with 3 Free PCP visits Health Insurance Plan Variant
86584WI0010008-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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