KP GA Signature Bronze Virtual Complete 5000/60 - 89942GA0050019 Health Insurance Plan

Kaiser Foundation Health Plan of Georgia health insurance plan with the Plan ID 89942GA0050019. The plan is called KP GA Signature Bronze Virtual Complete 5000/60.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.92% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.08% 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 64.83% (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 35.17% 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 89942GA0050019
Health Insurance Plan Year 2022
State Georgia
Health Insurance Issuer Kaiser Foundation Health Plan of Georgia
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 89942GA0050019-00
Provider Network(s) ['GAN002']
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 Georgia 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 - 89942GA0050019-00

Standard On Exchange Plan - 89942GA0050019-01

Open to Indians below 300% FPL - 89942GA0050019-02

Open to Indians above 300% FPL - 89942GA0050019-03

Last Plan Update Date Sat, 20 Nov 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.648274395
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 2
Business Year 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 50.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group $3000 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $1500 per person
Drug EHB Deductible, In Network (Tier 1), Individual $1,500
Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Drug EHB Deductible, Out of Network, Individual Not Applicable
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 0.9973
First Tier Utilization 100%
Formulary ID GAF031
Formulary URL URL
HIOS Product ID 89942GA005
Import Date 11/20/2021 2:46
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? Yes
Issuer Actuarial Value 64.92%
Issuer ID 89942
Issuer Marketplace Marketing Name Kaiser Permanente
Market Coverage Individual
Medical Drug Deductibles Integrated No
Medical Drug Maximum Out of Pocket Integrated Yes
Medical EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance 35.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $10000 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $5000 per person
Medical EHB Deductible, In Network (Tier 1), Individual $5,000
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Out of Network, Individual Not Applicable
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID GAN002
Out of Country Coverage Yes
Out of Country Coverage Description Urgent and Emergency Care only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Urgent and Emergency Care only
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 89942GA0050019-00
Plan Marketing Name KP GA Signature Bronze Virtual Complete 5000/60
Plan Type HMO
Plan Variant Marketing Name KP GA Signature Bronze Virtual Complete 5000/60
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,600
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $5,000
SBC Scenario, Having a Baby, Limit $50
SBC Scenario, Having Diabetes, Coinsurance $1,100
SBC Scenario, Having Diabetes, Copayment $700
SBC Scenario, Having Diabetes, Deductible $1,900
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $10
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID GAS003
Source Name HIOS
Specialist Requiring a Referral Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery
Plan ID 89942GA0050019
State Code GA
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
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $17000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,500
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 KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, 89942GA0050019

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

Frequently Asked Questions(FAQ) about KP GA Signature Bronze Virtual Complete 5000/60, 89942GA0050019 Health Insurance Plan, 89942GA0050019

  • Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, 89942GA0050019 support Mail Ordering?

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

  • Does (89942GA0050019) Health Insurance Plan, Variant (89942GA0050019-00) 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

    Does (89942GA0050019) Health Insurance Plan, Variant (89942GA0050019-00) have Out Of Country Coverage?

    Yes. Details: Urgent and Emergency Care only

    Does (89942GA0050019) Health Insurance Plan, Variant (89942GA0050019-00) have Out of Service Area Coverage?

    Yes. Details: Urgent and Emergency Care only

    Does (89942GA0050019) Health Insurance Plan, Variant (89942GA0050019-00) 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

    Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, Variant (89942GA0050019-00) offer Disease Management Programs for Asthma?

    Yes, the KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 offers Disease Management Program for Asthma.

    Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, Variant (89942GA0050019-00) offer Disease Management Programs for Heart disease?

    Yes, the KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 offers Disease Management Program for Heart disease.

    Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, Variant (89942GA0050019-00) offer Disease Management Programs for Depression?

    Yes, the KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 offers Disease Management Program for Depression.

    Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, Variant (89942GA0050019-00) offer Disease Management Programs for Diabetes?

    Yes, the KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 offers Disease Management Program for Diabetes.

    Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, Variant (89942GA0050019-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, Variant (89942GA0050019-00) offer Disease Management Programs for Low back pain?

    Yes, the KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 offers Disease Management Program for Low back pain.

    Does KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan, Variant (89942GA0050019-00) offer Disease Management Programs for Pregnancy?

    Yes, the KP GA Signature Bronze Virtual Complete 5000/60 Health Insurance Plan Variant 89942GA0050019-00 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