KP VA Gold 1000/20/Vision - 95185VA0500005 Health Insurance Plan

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. health insurance plan with the Plan ID 95185VA0500005. The plan is called KP VA Gold 1000/20/Vision.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 79.20% (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 20.80% 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 95185VA0500005
Health Insurance Plan Year 2022
State Virginia
Health Insurance Issuer Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 95185VA0500005-00
Provider Network(s) ['VAN001']
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 Virginia 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 - 95185VA0500005-00

Standard On Exchange Plan - 95185VA0500005-01

Last Plan Update Date Fri, 18 Mar 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.791973675
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 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 0.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group per group not applicable
Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Drug EHB Deductible, In Network (Tier 1), Individual $0
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, Weight Loss Programs
First Tier Utilization 100%
Formulary ID VAF003
Formulary URL URL
HIOS Product ID 95185VA050
HSA/HRA Employer Contribution No
Import Date 3/18/2022 20:01
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy Yes
Is a Referral Required for Specialist? Yes
Issuer ID 95185
Issuer Marketplace Marketing Name Kaiser Permanente
Market Coverage SHOP (Small Group)
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 0.00%
Medical EHB Deductible, In Network (Tier 1), Family Per Group $2000 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $1000 per person
Medical EHB Deductible, In Network (Tier 1), Individual $1,000
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 Gold
Multiple In Network Tiers No
National Network No
Network ID VAN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Care Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Care Only
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 95185VA0500005-00
Plan Marketing Name KP VA Gold 1000/20/Vision
Plan Type HMO
Plan Variant Marketing Name KP VA Gold 1000/20/Vision
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $500
SBC Scenario, Having a Baby, Deductible $1,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $800
SBC Scenario, Having Diabetes, Deductible $400
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $800
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,000
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID VAS001
Source Name SERFF
Specialist Requiring a Referral Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Routine Eye Exams.
Specialty Drug Maximum Coinsurance $300
Plan ID 95185VA0500005
State Code VA
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 $12800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6400 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,400
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 VA Gold 1000/20/Vision Health Insurance Plan, 95185VA0500005

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

Frequently Asked Questions(FAQ) about KP VA Gold 1000/20/Vision, 95185VA0500005 Health Insurance Plan, 95185VA0500005

  • Does KP VA Gold 1000/20/Vision Health Insurance Plan, 95185VA0500005 support Mail Ordering?

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

  • Does (95185VA0500005) Health Insurance Plan, Variant (95185VA0500005-00) 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, Weight Loss Programs

    Does (95185VA0500005) Health Insurance Plan, Variant (95185VA0500005-00) have Out Of Country Coverage?

    Yes. Details: Emergency Care Only

    Does (95185VA0500005) Health Insurance Plan, Variant (95185VA0500005-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Care Only

    Does (95185VA0500005) Health Insurance Plan, Variant (95185VA0500005-00) 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, Weight Loss Programs

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for Asthma?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 offers Disease Management Program for Asthma.

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for Heart disease?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 offers Disease Management Program for Heart disease.

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for Depression?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 offers Disease Management Program for Depression.

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for Diabetes?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 offers Disease Management Program for Diabetes.

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for Low back pain?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 offers Disease Management Program for Low back pain.

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for Pregnancy?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 offers Disease Management Program for Pregnancy.

    Does KP VA Gold 1000/20/Vision Health Insurance Plan, Variant (95185VA0500005-00) offer Disease Management Programs for Weight loss programs?

    Yes, the KP VA Gold 1000/20/Vision Health Insurance Plan Variant 95185VA0500005-00 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