| Field | Data |
|---|---|
| Health Insurance Plan ID | 71287OR0420003 |
| Health Insurance Plan Year | 2023 |
| State | Oregon |
| Health Insurance Issuer | Kaiser Foundation Healthplan of the NW |
| Plan Formulary Description URL | Formulary URL |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Wed, 14 Sep 2022 00:00 GMT |
| Last Import Date | Tue, 21 Mar 2023 13:10 GMT |
| Health Insurance Plan Variant | 71287OR0420003-04 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.739695366 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 73% AV Level Silver 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 | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| DEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| DEHBDedOutOfNetFamilyPerPerson | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Design 3 |
| 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 | 0.9984 |
| First Tier Utilization | 100% |
| Formulary ID | ORF023 |
| Formulary URL | URL |
| HIOS Product ID | 71287OR042 |
| Import Date | 8/12/2022 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? | Yes |
| Issuer ID | 71287 |
| 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 | 30.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $9600 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $4800 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $4,800 |
| 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 | Silver |
| 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 |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 71287OR0420003-04 |
| Plan Marketing Name | KP Oregon Standard Silver Plan |
| Plan Type | EPO |
| Plan Variant Marketing Name | KP Oregon Standard Silver Plan |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,300 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $4,800 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $100 |
| SBC Scenario, Having Diabetes, Copayment | $1,200 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $70 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,800 |
| 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 | 71287OR0420003 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $14500 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7250 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,250 |
| 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 |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about KP Oregon Standard Silver Plan, 71287OR0420003 Health Insurance Plan, 71287OR0420003
Does KP Oregon Standard Silver Plan Health Insurance Plan, 71287OR0420003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (71287OR0420003) Health Insurance Plan, Variant (71287OR0420003-04) 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 (71287OR0420003) Health Insurance Plan, Variant (71287OR0420003-04) have Out Of Country Coverage?
Yes. Details: Emergency medical conditions, including prescription drugs
Does (71287OR0420003) Health Insurance Plan, Variant (71287OR0420003-04) have Out of Service Area Coverage?
Yes. Details: Emergency medical conditions, including prescription drugs
Does (71287OR0420003) Health Insurance Plan, Variant (71287OR0420003-04) 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 Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for Asthma?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for Asthma.
Does KP Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for Heart disease?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for Heart disease.
Does KP Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for Depression?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for Depression.
Does KP Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for Diabetes?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for Diabetes.
Does KP Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for High blood pressure & high cholesterol.
Does KP Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for Low back pain?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for Low back pain.
Does KP Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for Pain management?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for Pain management.
Does KP Oregon Standard Silver Plan Health Insurance Plan, Variant (71287OR0420003-04) offer Disease Management Programs for Pregnancy?
Yes, the KP Oregon Standard Silver Plan Health Insurance Plan Variant 71287OR0420003-04 offers Disease Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 21 Mar 2023 13:10 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