Navigator Bronze HSA 7050 - 10091OR0700011 Health Insurance Plan

PacificSource Health Plans health insurance plan with the Plan ID 10091OR0700011. The plan is called Navigator Bronze HSA 7050.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.05% (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 35.95% 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 10091OR0700011
Health Insurance Plan Year 2023
State Oregon
Health Insurance Issuer PacificSource Health Plans
Health Insurance Plan Variant 10091OR0700011-01
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 On Exchange Plan - 10091OR0700011-01

Last Plan Update Date Mon, 23 Jan 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Navigator Bronze HSA 7050 Health Insurance Plan Variant 10091OR0700011-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.640546015
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered Yes
CSR Variation Type Standard Bronze On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, Pregnancy
First Tier Utilization 100%
Formulary ID ORF014
HIOS Product ID 10091OR070
HSA/HRA Employer Contribution No
Import Date 1/23/2023
HSA Eligible No
IsItANewPlan Existing
Notice Required for Pregnancy No
Issuer ID 10091
Market Coverage SHOP (Small Group)
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network Yes
Network ID ORN002
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Care Services Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description In and out-of-network providers
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 10091OR0700011-01
Plan Marketing Name Navigator Bronze HSA 7050
Plan Type PPO
Plan Variant Marketing Name Navigator Bronze HSA 7050
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $7,050
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,400
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 ORS003
Source Name SERFF
Plan ID 10091OR0700011
State Code OR
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family per person not applicable | per group 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 person not applicable | per group 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 $7050 per person | $14100 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $7,050
TEHBDedOutofNetFamily $10000 per person | $20000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Individual $10,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family $7050 per person | $14100 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,050
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family $15000 per person | $30000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $15,000
Unique Plan Design No
Version Number 1
Wellness Program Offered Yes

Copay & Coinsurance of Navigator Bronze HSA 7050 Health Insurance Plan, 10091OR0700011

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

Frequently Asked Questions(FAQ) about Navigator Bronze HSA 7050, 10091OR0700011 Health Insurance Plan, 10091OR0700011

  • Does Navigator Bronze HSA 7050 Health Insurance Plan, 10091OR0700011 support Mail Ordering?

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

  • Does (10091OR0700011) Health Insurance Plan, Variant (10091OR0700011-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy

    Does (10091OR0700011) Health Insurance Plan, Variant (10091OR0700011-01) have Out Of Country Coverage?

    Yes. Details: Emergency Care Services Only

    Does (10091OR0700011) Health Insurance Plan, Variant (10091OR0700011-01) have Out of Service Area Coverage?

    Yes. Details: In and out-of-network providers

    Does (10091OR0700011) Health Insurance Plan, Variant (10091OR0700011-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy

    Does Navigator Bronze HSA 7050 Health Insurance Plan, Variant (10091OR0700011-01) offer Disease Management Programs for Asthma?

    Yes, the Navigator Bronze HSA 7050 Health Insurance Plan Variant 10091OR0700011-01 offers Disease Management Program for Asthma.

    Does Navigator Bronze HSA 7050 Health Insurance Plan, Variant (10091OR0700011-01) offer Disease Management Programs for Heart disease?

    Yes, the Navigator Bronze HSA 7050 Health Insurance Plan Variant 10091OR0700011-01 offers Disease Management Program for Heart disease.

    Does Navigator Bronze HSA 7050 Health Insurance Plan, Variant (10091OR0700011-01) offer Disease Management Programs for Diabetes?

    Yes, the Navigator Bronze HSA 7050 Health Insurance Plan Variant 10091OR0700011-01 offers Disease Management Program for Diabetes.

    Does Navigator Bronze HSA 7050 Health Insurance Plan, Variant (10091OR0700011-01) offer Disease Management Programs for Pregnancy?

    Yes, the Navigator Bronze HSA 7050 Health Insurance Plan Variant 10091OR0700011-01 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