KP HI Gold 0/30 - 60612HI0110002 Health Insurance Plan

Kaiser Foundation Health Plan, Inc. health insurance plan with the Plan ID 60612HI0110002. The plan is called KP HI Gold 0/30.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.81% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.19% 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 82.57% (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 17.43% 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 60612HI0110002
Health Insurance Plan Year 2022
State Hawaii
Health Insurance Issuer Kaiser Foundation Health Plan, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 60612HI0110002-01
Provider Network(s) ['HIN001']
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 On Exchange Plan - 60612HI0110002-01

Open to Indians below 300% FPL - 60612HI0110002-02

Open to Indians above 300% FPL - 60612HI0110002-03

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

KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.825744892
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 Gold On 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 0.9946
First Tier Utilization 100%
Formulary ID HIF002
Formulary URL URL
HIOS Product ID 60612HI011
Import Date 8/18/2021 20:00
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 81.81%
Issuer ID 60612
Issuer Marketplace Marketing Name Kaiser Permanente
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID HIN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Services, Urgent Care and Authorized Referrals
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 60612HI0110002-01
Plan Marketing Name KP HI Gold 0/30
Plan Type HMO
Plan Variant Marketing Name KP HI Gold 0/30
QHP/Non QHP On the Exchange
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $2,500
SBC Scenario, Having Diabetes, Coinsurance $300
SBC Scenario, Having Diabetes, Copayment $1,300
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $200
SBC Scenario, Treatment of a Simple Fracture, Copayment $700
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID HIS001
Source Name SERFF
Specialist Requiring a Referral Referral required for certain specialists
Plan ID 60612HI0110002
State Code HI
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $8000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $8,000
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 30.00%
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
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 $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,000
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 KP HI Gold 0/30 Health Insurance Plan, 60612HI0110002

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

Frequently Asked Questions(FAQ) about KP HI Gold 0/30, 60612HI0110002 Health Insurance Plan, 60612HI0110002

  • Does KP HI Gold 0/30 Health Insurance Plan, 60612HI0110002 support Mail Ordering?

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

  • Does (60612HI0110002) Health Insurance Plan, Variant (60612HI0110002-01) 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 (60612HI0110002) Health Insurance Plan, Variant (60612HI0110002-01) have Out Of Country Coverage?

    Yes. Details: Emergency Services

    Does (60612HI0110002) Health Insurance Plan, Variant (60612HI0110002-01) have Out of Service Area Coverage?

    Yes. Details: Emergency Services, Urgent Care and Authorized Referrals

    Does (60612HI0110002) Health Insurance Plan, Variant (60612HI0110002-01) 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 KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for Asthma?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 offers Disease Management Program for Asthma.

    Does KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for Heart disease?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 offers Disease Management Program for Heart disease.

    Does KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for Depression?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 offers Disease Management Program for Depression.

    Does KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for Diabetes?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 offers Disease Management Program for Diabetes.

    Does KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for Low back pain?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 offers Disease Management Program for Low back pain.

    Does KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for Pregnancy?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 offers Disease Management Program for Pregnancy.

    Does KP HI Gold 0/30 Health Insurance Plan, Variant (60612HI0110002-01) offer Disease Management Programs for Weight loss programs?

    Yes, the KP HI Gold 0/30 Health Insurance Plan Variant 60612HI0110002-01 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