KP VA Silver 6500/40/Vision - 95185VA0530016 Health Insurance Plan

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. health insurance plan with the Plan ID 95185VA0530016. The plan is called KP VA Silver 6500/40/Vision.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 67.00% (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 33.00% 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 95185VA0530016
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 95185VA0530016-00
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 - 95185VA0530016-00

Standard On Exchange Plan - 95185VA0530016-01

Open to Indians below 300% FPL - 95185VA0530016-02

Open to Indians above 300% FPL - 95185VA0530016-03

73% AV Silver Plan - 95185VA0530016-04

87% AV Silver Plan - 95185VA0530016-05

94% AV Silver Plan - 95185VA0530016-06

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

KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.670002153
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 Silver 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, Weight Loss Programs
EHB Percent of Total Premium 0.9914
First Tier Utilization 100%
Formulary ID VAF008
Formulary URL URL
HIOS Product ID 95185VA053
Import Date 3/18/2022 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 Yes
Is a Referral Required for Specialist? Yes
Issuer ID 95185
Issuer Marketplace Marketing Name Kaiser Permanente
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
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) 95185VA0530016-00
Plan Marketing Name KP VA Silver 6500/40/Vision
Plan Type HMO
Plan Variant Marketing Name KP VA Silver 6500/40/Vision
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $700
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $6,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $200
SBC Scenario, Having Diabetes, Copayment $1,300
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 $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID VAS002
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 $250
Plan ID 95185VA0530016
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
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 $13000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $6500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,500
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 VA Silver 6500/40/Vision Health Insurance Plan, 95185VA0530016

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

Frequently Asked Questions(FAQ) about KP VA Silver 6500/40/Vision, 95185VA0530016 Health Insurance Plan, 95185VA0530016

  • Does KP VA Silver 6500/40/Vision Health Insurance Plan, 95185VA0530016 support Mail Ordering?

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

  • Does (95185VA0530016) Health Insurance Plan, Variant (95185VA0530016-00) 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 (95185VA0530016) Health Insurance Plan, Variant (95185VA0530016-00) have Out Of Country Coverage?

    Yes. Details: Emergency Care Only

    Does (95185VA0530016) Health Insurance Plan, Variant (95185VA0530016-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Care Only

    Does (95185VA0530016) Health Insurance Plan, Variant (95185VA0530016-00) 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 Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for Asthma?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 offers Disease Management Program for Asthma.

    Does KP VA Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for Heart disease?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 offers Disease Management Program for Heart disease.

    Does KP VA Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for Depression?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 offers Disease Management Program for Depression.

    Does KP VA Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for Diabetes?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 offers Disease Management Program for Diabetes.

    Does KP VA Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does KP VA Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for Low back pain?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 offers Disease Management Program for Low back pain.

    Does KP VA Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for Pregnancy?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 offers Disease Management Program for Pregnancy.

    Does KP VA Silver 6500/40/Vision Health Insurance Plan, Variant (95185VA0530016-00) offer Disease Management Programs for Weight loss programs?

    Yes, the KP VA Silver 6500/40/Vision Health Insurance Plan Variant 95185VA0530016-00 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