Moda Health Affinity Silver 3500 - 39424OR1620053 Health Insurance Plan

Moda Health Plan, Inc. health insurance plan with the Plan ID 39424OR1620053. The plan is called Moda Health Affinity Silver 3500.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 68.42% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 31.58% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 39424OR1620053
Health Insurance Plan Year 2022
State Oregon
Health Insurance Issuer Moda Health Plan, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 39424OR1620053-00
Provider Network(s) ['ORN002']
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 Oregon 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 - 39424OR1620053-00

Standard On Exchange Plan - 39424OR1620053-01

Open to Indians below 300% FPL - 39424OR1620053-02

Open to Indians above 300% FPL - 39424OR1620053-03

73% AV Silver Plan - 39424OR1620053-04

87% AV Silver Plan - 39424OR1620053-05

94% AV Silver Plan - 39424OR1620053-06

Last Plan Update Date Mon, 02 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 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 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 0.9984
First Tier Utilization 100%
Formulary ID ORF004
Formulary URL URL
HIOS Product ID 39424OR162
Import Date 8/2/2021 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 Actuarial Value 68.42%
Issuer ID 39424
Issuer Marketplace Marketing Name Moda Health Plan, Inc.
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 ORN002
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 39424OR1620053-00
Plan Marketing Name Moda Health Affinity Silver 3500
Plan Type EPO
Plan Variant Marketing Name Moda Health Affinity Silver 3500
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,200
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $3,500
SBC Scenario, Having a Baby, Limit $50
SBC Scenario, Having Diabetes, Coinsurance $1,700
SBC Scenario, Having Diabetes, Copayment $300
SBC Scenario, Having Diabetes, Deductible $400
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,300
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ORS002
Source Name SERFF
Plan ID 39424OR1620053
State Code OR
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 $7000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $3500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $3,500
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 $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
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 Yes
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Moda Health Affinity Silver 3500 Health Insurance Plan, 39424OR1620053

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

Frequently Asked Questions(FAQ) about Moda Health Affinity Silver 3500, 39424OR1620053 Health Insurance Plan, 39424OR1620053

  • Does Moda Health Affinity Silver 3500 Health Insurance Plan, 39424OR1620053 support Mail Ordering?

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

  • Does (39424OR1620053) Health Insurance Plan, Variant (39424OR1620053-00) 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 (39424OR1620053) Health Insurance Plan, Variant (39424OR1620053-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (39424OR1620053) Health Insurance Plan, Variant (39424OR1620053-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

    Does (39424OR1620053) Health Insurance Plan, Variant (39424OR1620053-00) 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 Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for Asthma?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 offers Disease Management Program for Asthma.

    Does Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for Heart disease?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 offers Disease Management Program for Heart disease.

    Does Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for Depression?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 offers Disease Management Program for Depression.

    Does Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for Diabetes?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 offers Disease Management Program for Diabetes.

    Does Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for Low back pain?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 offers Disease Management Program for Low back pain.

    Does Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for Pregnancy?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 offers Disease Management Program for Pregnancy.

    Does Moda Health Affinity Silver 3500 Health Insurance Plan, Variant (39424OR1620053-00) offer Disease Management Programs for Weight loss programs?

    Yes, the Moda Health Affinity Silver 3500 Health Insurance Plan Variant 39424OR1620053-00 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