Providence Oregon Standard Silver Plan - Signature Network - 56707OR1360004 Health Insurance Plan

Providence Health Plan health insurance plan with the Plan ID 56707OR1360004. The plan is called Providence Oregon Standard Silver Plan - Signature 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 56707OR1360004
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 56707OR1360004-03
Provider Network(s) ['ORN001']
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 Off Exchange Plan - 56707OR1360004-00

Standard On Exchange Plan - 56707OR1360004-01

Open to Indians below 300% FPL - 56707OR1360004-02

Open to Indians above 300% FPL - 56707OR1360004-03

73% AV Silver Plan - 56707OR1360004-04

87% AV Silver Plan - 56707OR1360004-05

94% AV Silver Plan - 56707OR1360004-06

Last Plan Update Date Tue, 02 Nov 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 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 Limited Cost Sharing Plan Variation
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 56707OR136
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? No
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 Yes
Network ID ORN001
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 no network; all other services National Network
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 56707OR1360004-03
Plan Marketing Name Providence Oregon Standard Silver Plan - Signature Network
Plan Type EPO
Plan Variant Marketing Name Providence Oregon Standard Silver Plan - Signature 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 ORS001
Source Name SERFF
Plan ID 56707OR1360004
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 - Signature Network Health Insurance Plan, 56707OR1360004

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

Frequently Asked Questions(FAQ) about Providence Oregon Standard Silver Plan - Signature Network, 56707OR1360004 Health Insurance Plan, 56707OR1360004

  • Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, 56707OR1360004 support Mail Ordering?

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

  • Does (56707OR1360004) Health Insurance Plan, Variant (56707OR1360004-03) 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 (56707OR1360004) Health Insurance Plan, Variant (56707OR1360004-03) have Out Of Country Coverage?

    Yes. Details: Emergency Only

    Does (56707OR1360004) Health Insurance Plan, Variant (56707OR1360004-03) have Out of Service Area Coverage?

    Yes. Details: Emergency Care and Urgent Care no network; all other services National Network

    Does (56707OR1360004) Health Insurance Plan, Variant (56707OR1360004-03) 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 - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for Asthma?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for Asthma.

    Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for Heart disease?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for Heart disease.

    Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for Depression?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for Depression.

    Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for Diabetes?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for Diabetes.

    Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for Low back pain?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for Low back pain.

    Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for Pregnancy?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for Pregnancy.

    Does Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan, Variant (56707OR1360004-03) offer Disease Management Programs for Weight loss programs?

    Yes, the Providence Oregon Standard Silver Plan - Signature Network Health Insurance Plan Variant 56707OR1360004-03 offers Disease Management Program for Weight loss programs.

 

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