myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) - 30252FL0070037 Health Insurance Plan

Health Options, Inc. health insurance plan with the Plan ID 30252FL0070037. The plan is called myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 68.22% (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 31.78% 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 30252FL0070037
Health Insurance Plan Year 2022
State Florida
Health Insurance Issuer Health Options, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 30252FL0070037-00
Provider Network(s) ['FLN002']
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 Florida 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 - 30252FL0070037-00

Standard On Exchange Plan - 30252FL0070037-01

Open to Indians below 300% FPL - 30252FL0070037-02

Open to Indians above 300% FPL - 30252FL0070037-03

73% AV Silver Plan - 30252FL0070037-04

87% AV Silver Plan - 30252FL0070037-05

94% AV Silver Plan - 30252FL0070037-06

Last Plan Update Date Thu, 04 Nov 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 30252FL0070037-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.682193245
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, Pain Management, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 0%
Formulary ID FLF030
Formulary URL URL
HIOS Product ID 30252FL007
Import Date 11/4/2021 1:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer ID 30252
Issuer Marketplace Marketing Name Florida Blue HMO (a BlueCross BlueShield FL company)
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers Yes
National Network No
Network ID FLN002
Out of Country Coverage Yes
Out of Country Coverage Description Accident and emergency services.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Accident and emergency services.
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 30252FL0070037-00
Plan Marketing Name myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$)
Plan Type HMO
Plan Variant Marketing Name myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $800
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $5,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,000
SBC Scenario, Having Diabetes, Deductible $4,000
SBC Scenario, Having Diabetes, Limit $30
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 $2,100
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 100%
Service Area ID FLS004
Source Name HIOS
Specialist Requiring a Referral All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.
Plan ID 30252FL0070037
State Code FL
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 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $11000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,500
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group $11000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person $5500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $5,500
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 $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group $16000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person $8000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $8,000
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 No

Copay & Coinsurance of myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, 30252FL0070037

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

Frequently Asked Questions(FAQ) about myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$), 30252FL0070037 Health Insurance Plan, 30252FL0070037

  • Does myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, 30252FL0070037 support Mail Ordering?

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

  • Does (30252FL0070037) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy

    Does (30252FL0070037) Health Insurance Plan, Variant (30252FL0070037-00) have Out Of Country Coverage?

    Yes. Details: Accident and emergency services.

    Does (30252FL0070037) Health Insurance Plan, Variant (30252FL0070037-00) have Out of Service Area Coverage?

    Yes. Details: Accident and emergency services.

    Does (30252FL0070037) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy

    Does myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs for Asthma?

    Yes, the myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 30252FL0070037-00 offers Disease Management Program for Asthma.

    Does myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs for Heart disease?

    Yes, the myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 30252FL0070037-00 offers Disease Management Program for Heart disease.

    Does myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs for Depression?

    Yes, the myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 30252FL0070037-00 offers Disease Management Program for Depression.

    Does myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs for Diabetes?

    Yes, the myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 30252FL0070037-00 offers Disease Management Program for Diabetes.

    Does myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 30252FL0070037-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan, Variant (30252FL0070037-00) offer Disease Management Programs for Pregnancy?

    Yes, the myBlue Silver 2204 ($0 Labs / $0 Virtual Visits / Rewards $$$) Health Insurance Plan Variant 30252FL0070037-00 offers Disease Management Program for Pregnancy.

 

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