McLaren Young Adult/Catastrophic - 74917MI0020004 Health Insurance Plan

McLaren Health Plan Community health insurance plan with the Plan ID 74917MI0020004. The plan is called McLaren Young Adult/Catastrophic.

Health Insurance Plan ID 74917MI0020004
Health Insurance Plan Year 2023
State Michigan
Health Insurance Issuer McLaren Health Plan Community
Plan Formulary Description URL Formulary URL
Health Insurance Plan Variant 74917MI0020004-00
Provider Network(s) ['MIN001']
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 Michigan 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 - 74917MI0020004-00

Standard On Exchange Plan - 74917MI0020004-01

Last Plan Update Date Thu, 12 Jan 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of McLaren Young Adult/Catastrophic Health Insurance Plan, 74917MI0020004-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
NO
Acupuncture
NO
Allergy Testing
YES

0.00% Coinsurance after deductible

100.00%
Bariatric Surgery

Limit: 1.0 Procedure(s) per Lifetime

YES

0.00% Coinsurance after deductible

100.00%
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy
YES

0.00% Coinsurance after deductible

100.00%
Chiropractic Care

Limit: 30.0 Visit(s) per Year

Limit combined with OT and PT.

YES

0.00% Coinsurance after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

0.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children
NO
Diabetes Education
YES

0.00% Coinsurance after deductible

100.00%
Dialysis
YES

0.00% Coinsurance after deductible

100.00%
Durable Medical Equipment
YES

0.00% Coinsurance after deductible

100.00%
Emergency Room Services
YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

0.00% Coinsurance after deductible

100.00%
Gender Affirming Care
NO
Generic Drugs
YES

0.00% Coinsurance after deductible

100.00%
Habilitation Services

Limit: 30.0 Visit(s) per Year

Yearly limits: PT and OT: 30 visits, Speech: 30 visits.

YES

0.00% Coinsurance after deductible

100.00%
Hearing Aids
NO
Home Health Care Services
YES

0.00% Coinsurance after deductible

100.00%
Hospice Services

Coverage includes inpatient and outpatient hospice care.

YES

0.00% Coinsurance after deductible

100.00%
Imaging (CT/PET Scans, MRIs)
YES

0.00% Coinsurance after deductible

100.00%
Infertility Treatment

Underlying causes only.

YES

0.00% Coinsurance after deductible

100.00%
Infusion Therapy
YES

0.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

0.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

0.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

0.00% Coinsurance after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Non-Preferred Brand Drugs
YES

0.00% Coinsurance after deductible

100.00%
Nutritional Counseling

Limit: 6.0 Visit(s) per Year

Dietician Services.

YES

0.00% Coinsurance after deductible

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

0.00% Coinsurance after deductible

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

0.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 30.0 Visit(s) per Year

PT/OT/Chiro - combined visits per contract year; 30 ST per contract year; 30 cardiac/pulmonary visits per contract year.

YES

0.00% Coinsurance after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

0.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs
YES

0.00% Coinsurance after deductible

100.00%
Prenatal and Postnatal Care
YES

0.00% Coinsurance after deductible

100.00%
Preventive Care/Screening/Immunization
YES

0.00%

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

0.00% Coinsurance after deductible

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

0.00% Coinsurance after deductible

100.00%
Radiation
YES

0.00% Coinsurance after deductible

100.00%
Reconstructive Surgery
YES

0.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 30.0 Visit(s) per Year

Combined with chiro.

YES

0.00% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 30.0 Visit(s) per Year

YES

0.00% Coinsurance after deductible

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)

Limit: 1.0 Exam(s) per Year

YES

0.00% Coinsurance after deductible

100.00%
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Year

YES

0.00% Coinsurance after deductible

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 45.0 Days per Year

YES

0.00% Coinsurance after deductible

100.00%
Specialist Visit
YES

0.00% Coinsurance after deductible

100.00%
Specialty Drugs
YES

0.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Transplant
YES

0.00% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental X-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.

YES

0.00% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities
YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Weight Loss Programs
YES

0.00% Coinsurance after deductible

100.00%
Well Baby Visits and Care
YES

0.00% Coinsurance after deductible

100.00%
X-rays and Diagnostic Imaging
YES

0.00% Coinsurance after deductible

100.00%

McLaren Young Adult/Catastrophic Health Insurance Plan Variant 74917MI0020004-00 Attributes

Plan Attribute Value
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 Standard Catastrophic Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
First Tier Utilization 100%
Formulary ID MIF001
Formulary URL URL
HIOS Product ID 74917MI002
Import Date 1/12/2023 20:00
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 74917
Issuer Marketplace Marketing Name McLaren Health Plan Community
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Catastrophic
Multiple In Network Tiers No
National Network Yes
Network ID MIN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 74917MI0020004-00
Plan Marketing Name McLaren Young Adult/Catastrophic
Plan Type HMO
Plan Variant Marketing Name McLaren Young Adult/Catastrophic
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $9,100
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,600
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
Service Area ID MIS001
Source Name SERFF
Plan ID 74917MI0020004
State Code MI
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 $18200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $9100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $9,100
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 $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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

Copay & Coinsurance of McLaren Young Adult/Catastrophic Health Insurance Plan, 74917MI0020004

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

Frequently Asked Questions(FAQ) about McLaren Young Adult/Catastrophic, 74917MI0020004 Health Insurance Plan, 74917MI0020004

  • Does McLaren Young Adult/Catastrophic Health Insurance Plan, 74917MI0020004 support Mail Ordering?

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

  • Does (74917MI0020004) Health Insurance Plan, Variant (74917MI0020004-00) have Out Of Country Coverage?

    Yes. Details: Emergency

    Does (74917MI0020004) Health Insurance Plan, Variant (74917MI0020004-00) have Out of Service Area Coverage?

    Yes. Details: Emergency

 

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