PacificSource Oregon Standard Bronze Plan Voyager - 10091OR0700036 Health Insurance Plan
PacificSource Health Plans health insurance plan with the Plan ID 10091OR0700036. The plan is called PacificSource Oregon Standard Bronze Plan Voyager.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.65% (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 35.35% 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 | 10091OR0700036 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | PacificSource Health Plans | ||||||||||||||||||
| Health Insurance Plan Variant | 10091OR0700036-01 | ||||||||||||||||||
| Provider Network(s) | ['ORN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan Variant 10091OR0700036-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.646538804 |
| 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 | ORF016 |
| 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 | ORN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Care 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) | 10091OR0700036-01 |
| Plan Marketing Name | PacificSource Oregon Standard Bronze Plan Voyager |
| Plan Type | PPO |
| Plan Variant Marketing Name | PacificSource Oregon Standard Bronze Plan Voyager |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $8,800 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $700 |
| SBC Scenario, Having Diabetes, Deductible | $4,000 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ORS001 |
| Source Name | SERFF |
| Plan ID | 10091OR0700036 |
| 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 | $8800 per person | $17600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $8,800 |
| 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 | $8800 per person | $17600 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,800 |
| 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 PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan, 10091OR0700036
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about PacificSource Oregon Standard Bronze Plan Voyager, 10091OR0700036 Health Insurance Plan, 10091OR0700036
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Does PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan, 10091OR0700036 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (10091OR0700036) Health Insurance Plan, Variant (10091OR0700036-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does (10091OR0700036) Health Insurance Plan, Variant (10091OR0700036-01) have Out Of Country Coverage?
Yes. Details: Emergency Care Only
Does (10091OR0700036) Health Insurance Plan, Variant (10091OR0700036-01) have Out of Service Area Coverage?
Yes. Details: In and out-of-network providers
Does (10091OR0700036) Health Insurance Plan, Variant (10091OR0700036-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, Pregnancy
Does PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan, Variant (10091OR0700036-01) offer Disease Management Programs for Asthma?
Yes, the PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan Variant
10091OR0700036-01 offers Disease
Management Program for Asthma.
Does PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan, Variant (10091OR0700036-01) offer Disease Management Programs for Heart disease?
Yes, the PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan Variant
10091OR0700036-01 offers Disease
Management Program for Heart disease.
Does PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan, Variant (10091OR0700036-01) offer Disease Management Programs for Diabetes?
Yes, the PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan Variant
10091OR0700036-01 offers Disease
Management Program for Diabetes.
Does PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan, Variant (10091OR0700036-01) offer Disease Management Programs for Pregnancy?
Yes, the PacificSource Oregon Standard Bronze Plan Voyager Health Insurance Plan Variant
10091OR0700036-01 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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