| Field | Data |
|---|---|
| Health Insurance Plan ID | 99969OH0080325 |
| Health Insurance Plan Year | 2023 |
| State | Ohio |
| Health Insurance Issuer | Medical Health Insuring Corp. of Ohio |
| Plan Formulary Description URL | Formulary URL |
| Last Plan Update Date | Wed, 15 Mar 2023 00:00 GMT |
| Last Import Date | Sun, 01 Oct 2023 10:53 GMT |
| Health Insurance Plan Variant | 99969OH0080325-03 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.646860803 |
| 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 | Limited Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Diabetes |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 20% |
| Formulary ID | OHF005 |
| Formulary URL | URL |
| HIOS Product ID | 99969OH008 |
| Import Date | 3/15/2023 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? | No |
| Issuer ID | 99969 |
| Issuer Marketplace Marketing Name | MedMutual |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | OHN003 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Covered as Non-Network |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 99969OH0080325-03 |
| Plan Marketing Name | Market HMO 7000 HSA - Northern Ohio |
| Plan Type | HMO |
| Plan Variant Marketing Name | Market HMO 7000 - Northern Ohio |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $7,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,200 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| 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 |
| Second Tier Utilization | 80% |
| Service Area ID | OHS006 |
| Source Name | SERFF |
| Plan ID | 99969OH0080325 |
| State Code | OH |
| 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 | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $14000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $7000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $7,000 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $14000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $7000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $7,000 |
| TEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| TEHBDedOutOfNetFamilyPerPerson | 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 | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $7000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $7,000 |
| 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 |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Market HMO 7000 HSA - Northern Ohio, 99969OH0080325 Health Insurance Plan, 99969OH0080325
Does Market HMO 7000 HSA - Northern Ohio Health Insurance Plan, 99969OH0080325 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (99969OH0080325) Health Insurance Plan, Variant (99969OH0080325-03) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes
Does (99969OH0080325) Health Insurance Plan, Variant (99969OH0080325-03) have Out Of Country Coverage?
Yes. Details: Emergency Only
Does (99969OH0080325) Health Insurance Plan, Variant (99969OH0080325-03) have Out of Service Area Coverage?
Yes. Details: Covered as Non-Network
Does (99969OH0080325) Health Insurance Plan, Variant (99969OH0080325-03) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Diabetes
Does Market HMO 7000 - Northern Ohio Health Insurance Plan, Variant (99969OH0080325-03) offer Disease Management Programs for Asthma?
Yes, the Market HMO 7000 - Northern Ohio Health Insurance Plan Variant 99969OH0080325-03 offers Disease Management Program for Asthma.
Does Market HMO 7000 - Northern Ohio Health Insurance Plan, Variant (99969OH0080325-03) offer Disease Management Programs for Diabetes?
Yes, the Market HMO 7000 - Northern Ohio Health Insurance Plan Variant 99969OH0080325-03 offers Disease Management Program for Diabetes.
Disclaimer: This is based on the import(Date: Sun, 01 Oct 2023 10:53 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