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Piedmont Gold 2100 - 37204VA0080001 Health Insurance Plan

Piedmont Community HealthCare HMO, Inc. health insurance plan with the Plan ID 37204VA0080001. The plan is called Piedmont Gold 2100.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 76.32% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 23.68% of the costs of all covered benefits (according to the Issuer).

Field Data
Health Insurance Plan ID37204VA0080001
Health Insurance Plan Year2022
StateVirginia
Health Insurance IssuerPiedmont Community HealthCare HMO, Inc.
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateMon, 16 Aug 2021 00:00 GMT
Last Import DateSun, 24 Sep 2023 09:34 GMT
Health Insurance Plan Variant37204VA0080001-01
 
Available Variants of the Health Plan

37204VA0080001-00

37204VA0080001-01

37204VA0080001-02

37204VA0080001-03

Piedmont Gold 2100 Health Insurance Plan Variant 37204VA0080001-01 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits0
Begin Primary Care Deductible Coinsurance After Number Of Copays0
Business Year2022
Child-Only OfferingAllows Adult and Child-Only
Composite Rating OfferedNo
CSR Variation TypeStandard Gold On Exchange Plan
Dental Only PlanNo
Disease Management Programs OfferedHeart Disease, Diabetes
EHB Percent of Total Premium 1
First Tier Utilization100%
Formulary IDVAF001
Formulary URLURL
HIOS Product ID37204VA008
Import Date8/16/2021 20:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment$0.00
Inpatient Copayment Maximum Days0
HSA EligibleNo
New/Existing PlanExisting
Notice Required for PregnancyNo
Is a Referral Required for Specialist?No
Issuer Actuarial Value76.32%
Issuer ID37204
Issuer Marketplace Marketing NamePiedmont Community HealthCare HMO, Inc.
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelGold
Multiple In Network TiersNo
National NetworkNo
Network IDVAN001
Out of Country CoverageNo
Out of Service Area CoverageNo
Plan BrochureURL
Plan Effective Date1/1/2022
Plan Expiration Date12/31/2022
Plan ID (Standard Component ID with Variant) 37204VA0080001-01
Plan Marketing NamePiedmont Gold 2100
Plan TypeHMO
Plan Variant Marketing NamePiedmont Gold 2100
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$2,100
SBC Scenario, Having a Baby, Copayment$10
SBC Scenario, Having a Baby, Deductible$2,100
SBC Scenario, Having a Baby, Limit$60
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$1,400
SBC Scenario, Having Diabetes, Deductible$100
SBC Scenario, Having Diabetes, Limit$20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance$70
SBC Scenario, Treatment of a Simple Fracture, Copayment$200
SBC Scenario, Treatment of a Simple Fracture, Deductible$2,100
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Service Area IDVAS001
Source NameSERFF
Plan ID37204VA0080001
State CodeVA
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, IndividualNot Applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Groupper group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Personper person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, IndividualNot Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance20.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group$6300 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$2100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$2,100
TEHBDedOutOfNetFamilyPerGroupper group not applicable
TEHBDedOutOfNetFamilyPerPersonper person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, IndividualNot 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 Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, IndividualNot Applicable
Unique Plan DesignYes
URL for Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program OfferedNo

Copay & Coinsurance of Piedmont Gold 2100 Health Insurance Plan, 37204VA0080001

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

Frequently Asked Questions(FAQ) about Piedmont Gold 2100, 37204VA0080001 Health Insurance Plan, 37204VA0080001

Does Piedmont Gold 2100 Health Insurance Plan, 37204VA0080001 support Mail Ordering?

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

Does (37204VA0080001) Health Insurance Plan, Variant (37204VA0080001-01) offer Disease Management Programs?

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

Does (37204VA0080001) Health Insurance Plan, Variant (37204VA0080001-01) have Out Of Country Coverage?

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

Does (37204VA0080001) Health Insurance Plan, Variant (37204VA0080001-01) 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 (37204VA0080001) Health Insurance Plan, Variant (37204VA0080001-01) offer Disease Management Programs?

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

Does Piedmont Gold 2100 Health Insurance Plan, Variant (37204VA0080001-01) offer Disease Management Programs for Heart disease?

Yes, the Piedmont Gold 2100 Health Insurance Plan Variant 37204VA0080001-01 offers Disease Management Program for Heart disease.

Does Piedmont Gold 2100 Health Insurance Plan, Variant (37204VA0080001-01) offer Disease Management Programs for Diabetes?

Yes, the Piedmont Gold 2100 Health Insurance Plan Variant 37204VA0080001-01 offers Disease Management Program for Diabetes.

 

Disclaimer: This is based on the import(Date: Sun, 24 Sep 2023 09:34 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