KP OR Bronze 5500/50 - 71287OR0420014 Health Insurance Plan

Kaiser Foundation Healthplan of the NW health insurance plan with the Plan ID 71287OR0420014. The plan is called KP OR Bronze 5500/50.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.71% (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 35.29% 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 71287OR0420014
Health Insurance Plan Year 2022
State Oregon
Health Insurance Issuer Kaiser Foundation Healthplan of the NW
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 71287OR0420014-00
Provider Network(s) ['ORN001']
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 Oregon 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 - 71287OR0420014-00

Standard On Exchange Plan - 71287OR0420014-01

Open to Indians below 300% FPL - 71287OR0420014-02

Open to Indians above 300% FPL - 71287OR0420014-03

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

KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.647120334
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 Bronze Off 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
EHB Percent of Total Premium 0.9982
First Tier Utilization 100%
Formulary ID ORF017
Formulary URL URL
HIOS Product ID 71287OR042
Import Date 8/12/2021 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 ID 71287
Issuer Marketplace Marketing Name Kaiser Permanente
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network No
Network ID ORN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency medical conditions, including prescription drugs
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency medical conditions, including prescription drugs. Out of Area Dependent; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 71287OR0420014-00
Plan Marketing Name KP OR Bronze 5500/50
Plan Type EPO
Plan Variant Marketing Name KP OR Bronze 5500/50
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,500
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $5,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $100
SBC Scenario, Having Diabetes, Copayment $400
SBC Scenario, Having Diabetes, Deductible $4,400
SBC Scenario, Having Diabetes, Limit $0
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 ORS001
Source Name SERFF
Specialist Requiring a Referral A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.
Plan ID 71287OR0420014
State Code OR
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 35.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $11000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,500
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 $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 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 Yes

Copay & Coinsurance of KP OR Bronze 5500/50 Health Insurance Plan, 71287OR0420014

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

Frequently Asked Questions(FAQ) about KP OR Bronze 5500/50, 71287OR0420014 Health Insurance Plan, 71287OR0420014

  • Does KP OR Bronze 5500/50 Health Insurance Plan, 71287OR0420014 support Mail Ordering?

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

  • Does (71287OR0420014) Health Insurance Plan, Variant (71287OR0420014-00) 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 (71287OR0420014) Health Insurance Plan, Variant (71287OR0420014-00) have Out Of Country Coverage?

    Yes. Details: Emergency medical conditions, including prescription drugs

    Does (71287OR0420014) Health Insurance Plan, Variant (71287OR0420014-00) have Out of Service Area Coverage?

    Yes. Details: Emergency medical conditions, including prescription drugs. Out of Area Dependent; 20% Coinsurance of the actual fee charged; Allowance of 5 office visits, 5 Diagnostic Xrays and 5 prescriptions

    Does (71287OR0420014) Health Insurance Plan, Variant (71287OR0420014-00) 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 OR Bronze 5500/50 Health Insurance Plan, Variant (71287OR0420014-00) offer Disease Management Programs for Asthma?

    Yes, the KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 offers Disease Management Program for Asthma.

    Does KP OR Bronze 5500/50 Health Insurance Plan, Variant (71287OR0420014-00) offer Disease Management Programs for Heart disease?

    Yes, the KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 offers Disease Management Program for Heart disease.

    Does KP OR Bronze 5500/50 Health Insurance Plan, Variant (71287OR0420014-00) offer Disease Management Programs for Depression?

    Yes, the KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 offers Disease Management Program for Depression.

    Does KP OR Bronze 5500/50 Health Insurance Plan, Variant (71287OR0420014-00) offer Disease Management Programs for Diabetes?

    Yes, the KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 offers Disease Management Program for Diabetes.

    Does KP OR Bronze 5500/50 Health Insurance Plan, Variant (71287OR0420014-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does KP OR Bronze 5500/50 Health Insurance Plan, Variant (71287OR0420014-00) offer Disease Management Programs for Low back pain?

    Yes, the KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 offers Disease Management Program for Low back pain.

    Does KP OR Bronze 5500/50 Health Insurance Plan, Variant (71287OR0420014-00) offer Disease Management Programs for Pregnancy?

    Yes, the KP OR Bronze 5500/50 Health Insurance Plan Variant 71287OR0420014-00 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