KP VA Platinum 500/20/Vision - 95185VA0500002 Health Insurance Plan
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. health insurance plan with the Plan ID 95185VA0500002. The plan is called KP VA Platinum 500/20/Vision.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 87.63% (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 12.37% 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 | 95185VA0500002 | ||||||||||||||||||
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| 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 | 95185VA0500002-00 | ||||||||||||||||||
| Provider Network(s) | ['VAN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Apr 2024 06:19 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Fri, 18 Mar 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Apr 2024 06:19 GMT |
KP VA Platinum 500/20/Vision Health Insurance Plan Variant 95185VA0500002-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.876331373 |
| 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 Platinum 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 | VAF001 |
| 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 | $1000 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $500 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $500 |
| 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 | Platinum |
| 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) | 95185VA0500002-00 |
| Plan Marketing Name | KP VA Platinum 500/20/Vision |
| Plan Type | HMO |
| Plan Variant Marketing Name | KP VA Platinum 500/20/Vision |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $200 |
| SBC Scenario, Having a Baby, Deductible | $500 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $600 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $500 |
| 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 | 95185VA0500002 |
| 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 | $5000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $2500 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $2,500 |
| 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 Platinum 500/20/Vision Health Insurance Plan, 95185VA0500002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about KP VA Platinum 500/20/Vision, 95185VA0500002 Health Insurance Plan, 95185VA0500002
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Does KP VA Platinum 500/20/Vision Health Insurance Plan, 95185VA0500002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (95185VA0500002) Health Insurance Plan, Variant (95185VA0500002-00) 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 (95185VA0500002) Health Insurance Plan, Variant (95185VA0500002-00) have Out Of Country Coverage?
Yes. Details: Emergency Care Only
Does (95185VA0500002) Health Insurance Plan, Variant (95185VA0500002-00) have Out of Service Area Coverage?
Yes. Details: Emergency Care Only
Does (95185VA0500002) Health Insurance Plan, Variant (95185VA0500002-00) 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 Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for Asthma?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for Asthma.
Does KP VA Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for Heart disease?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for Heart disease.
Does KP VA Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for Depression?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for Depression.
Does KP VA Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for Diabetes?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for Diabetes.
Does KP VA Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Does KP VA Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for Low back pain?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for Low back pain.
Does KP VA Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for Pregnancy?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for Pregnancy.
Does KP VA Platinum 500/20/Vision Health Insurance Plan, Variant (95185VA0500002-00) offer Disease Management Programs for Weight loss programs?
Yes, the KP VA Platinum 500/20/Vision Health Insurance Plan Variant
95185VA0500002-00 offers Disease
Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Tue, 16 Apr 2024 06:19 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