Providence Oregon Standard Silver Plan - Choice Network - 56707OR1330004 Health Insurance Plan
Providence Health Plan health insurance plan with the Plan ID 56707OR1330004. The plan is called Providence Oregon Standard Silver Plan - Choice Network.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.10% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.90% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 71.92% (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 28.08% 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 | 56707OR1330004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | Providence Health Plan | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 56707OR1330004-00 | ||||||||||||||||||
| Provider Network(s) | ['ORN003'] | ||||||||||||||||||
| 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 | Standard Off Exchange Plan - 56707OR1330004-00 Standard On Exchange Plan - 56707OR1330004-01 Open to Indians below 300% FPL - 56707OR1330004-02 Open to Indians above 300% FPL - 56707OR1330004-03 73% AV Silver Plan - 56707OR1330004-04 |
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| Last Plan Update Date | Tue, 02 Nov 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant 56707OR1330004-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.719234821 |
| 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 |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| 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 | ORF011 |
| Formulary URL | URL |
| HIOS Product ID | 56707OR133 |
| Import Date | 11/2/2021 20:01 |
| 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? | Yes |
| Issuer Actuarial Value | 71.10% |
| Issuer ID | 56707 |
| Issuer Marketplace Marketing Name | Providence Health Plan |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 30.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $7300 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $3650 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $3,650 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ORN003 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency Care and Urgent Care |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 56707OR1330004-00 |
| Plan Marketing Name | Providence Oregon Standard Silver Plan - Choice Network |
| Plan Type | EPO |
| Plan Variant Marketing Name | Providence Oregon Standard Silver Plan - Choice Network |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,700.00 |
| SBC Scenario, Having a Baby, Copayment | $10.00 |
| SBC Scenario, Having a Baby, Deductible | $3,650.00 |
| SBC Scenario, Having a Baby, Limit | $60.00 |
| SBC Scenario, Having Diabetes, Coinsurance | $0.00 |
| SBC Scenario, Having Diabetes, Copayment | $1,400.00 |
| SBC Scenario, Having Diabetes, Deductible | $900.00 |
| SBC Scenario, Having Diabetes, Limit | $20.00 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $100.00 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $400.00 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,700.00 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0.00 |
| Service Area ID | ORS003 |
| Source Name | SERFF |
| Specialist Requiring a Referral | All Non-PCP Providers |
| Plan ID | 56707OR1330004 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $17100 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8550 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,550 |
| 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 Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, 56707OR1330004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Providence Oregon Standard Silver Plan - Choice Network, 56707OR1330004 Health Insurance Plan, 56707OR1330004
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Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, 56707OR1330004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (56707OR1330004) Health Insurance Plan, Variant (56707OR1330004-00) 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 (56707OR1330004) Health Insurance Plan, Variant (56707OR1330004-00) have Out Of Country Coverage?
Yes. Details: Emergency Only
Does (56707OR1330004) Health Insurance Plan, Variant (56707OR1330004-00) have Out of Service Area Coverage?
Yes. Details: Emergency Care and Urgent Care
Does (56707OR1330004) Health Insurance Plan, Variant (56707OR1330004-00) 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 Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for Asthma?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for Asthma.
Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for Heart disease?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for Heart disease.
Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for Depression?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for Depression.
Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for Diabetes?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for Diabetes.
Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for High blood pressure & high cholesterol.
Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for Low back pain?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for Low back pain.
Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for Pregnancy?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for Pregnancy.
Does Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan, Variant (56707OR1330004-00) offer Disease Management Programs for Weight loss programs?
Yes, the Providence Oregon Standard Silver Plan - Choice Network Health Insurance Plan Variant
56707OR1330004-00 offers Disease
Management Program for Weight loss programs.
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