HMSA Silver PPO - 18350HI0880017 Health Insurance Plan

Hawaii Medical Service Association health insurance plan with the Plan ID 18350HI0880017. The plan is called HMSA Silver PPO .

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.77% (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 28.23% 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 18350HI0880017
Health Insurance Plan Year 2022
State Hawaii
Health Insurance Issuer Hawaii Medical Service Association
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 18350HI0880017-00
Provider Network(s) ['HIN003']
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 Hawaii 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 - 18350HI0880017-00

Standard On Exchange Plan - 18350HI0880017-01

Open to Indians below 300% FPL - 18350HI0880017-02

Open to Indians above 300% FPL - 18350HI0880017-03

73% AV Silver Plan - 18350HI0880017-04

87% AV Silver Plan - 18350HI0880017-05

94% AV Silver Plan - 18350HI0880017-06

Last Plan Update Date Tue, 07 Dec 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

HMSA Silver PPO Health Insurance Plan Variant 18350HI0880017-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.717686556
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 Silver Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy
EHB Percent of Total Premium 0.9908
First Tier Utilization 100%
Formulary ID HIF001
Formulary URL URL
HIOS Product ID 18350HI088
Import Date 12/7/2021 20:01
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 18350
Issuer Marketplace Marketing Name HMSA
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 Yes
Network ID HIN003
Out of Country Coverage Yes
Out of Country Coverage Description Covered
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Covered
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 18350HI0880017-00
Plan Marketing Name HMSA Silver PPO
Plan Type PPO
Plan Variant Marketing Name HMSA Silver PPO
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,600
SBC Scenario, Having a Baby, Copayment $60
SBC Scenario, Having a Baby, Deductible $2,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $900
SBC Scenario, Having Diabetes, Deductible $900
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID HIS001
Source Name SERFF
Plan ID 18350HI0880017
State Code HI
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $17100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $8550 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $8,550
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $5000 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $2500 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $2,500
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $5000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $2500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $2,500
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $5000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $2500 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $2,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $17100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8550 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,550
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $17100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $8550 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $8,550
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of HMSA Silver PPO Health Insurance Plan, 18350HI0880017

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

Frequently Asked Questions(FAQ) about HMSA Silver PPO , 18350HI0880017 Health Insurance Plan, 18350HI0880017

  • Does HMSA Silver PPO Health Insurance Plan, 18350HI0880017 support Mail Ordering?

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

  • Does (18350HI0880017) Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does (18350HI0880017) Health Insurance Plan, Variant (18350HI0880017-00) have Out Of Country Coverage?

    Yes. Details: Covered

    Does (18350HI0880017) Health Insurance Plan, Variant (18350HI0880017-00) have Out of Service Area Coverage?

    Yes. Details: Covered

    Does (18350HI0880017) Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does HMSA Silver PPO Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs for Asthma?

    Yes, the HMSA Silver PPO Health Insurance Plan Variant 18350HI0880017-00 offers Disease Management Program for Asthma.

    Does HMSA Silver PPO Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs for Heart disease?

    Yes, the HMSA Silver PPO Health Insurance Plan Variant 18350HI0880017-00 offers Disease Management Program for Heart disease.

    Does HMSA Silver PPO Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs for Depression?

    Yes, the HMSA Silver PPO Health Insurance Plan Variant 18350HI0880017-00 offers Disease Management Program for Depression.

    Does HMSA Silver PPO Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs for Diabetes?

    Yes, the HMSA Silver PPO Health Insurance Plan Variant 18350HI0880017-00 offers Disease Management Program for Diabetes.

    Does HMSA Silver PPO Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the HMSA Silver PPO Health Insurance Plan Variant 18350HI0880017-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does HMSA Silver PPO Health Insurance Plan, Variant (18350HI0880017-00) offer Disease Management Programs for Pregnancy?

    Yes, the HMSA Silver PPO Health Insurance Plan Variant 18350HI0880017-00 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