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QUARTZ ONE BRONZE I201 - 37833WI0510213 Health Insurance Plan

Quartz Health Benefit Plans Corporation health insurance plan with the Plan ID 37833WI0510213. The plan is called QUARTZ ONE BRONZE I201.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.78% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.22% 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 64.21% (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 35.79% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Field Data
Health Insurance Plan ID37833WI0510213
Health Insurance Plan Year2023
StateWisconsin
Health Insurance IssuerQuartz Health Benefit Plans Corporation
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateFri, 28 Apr 2023 00:00 GMT
Last Import DateSun, 01 Oct 2023 10:53 GMT
Health Insurance Plan Variant37833WI0510213-00
 
Available Variants of the Health Plan

37833WI0510213-00

37833WI0510213-01

37833WI0510213-02

37833WI0510213-03

QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan Variant 37833WI0510213-00 Attributes

Plan Attribute Value
AV Calculator Output Number0.642068827
Begin Primary Care Cost-Sharing After Number Of Visits0
Begin Primary Care Deductible Coinsurance After Number Of Copays0
Business Year2023
Child-Only OfferingAllows Adult and Child-Only
Composite Rating OfferedNo
CSR Variation TypeStandard Bronze Off Exchange Plan
Dental Only PlanNo
Design TypeNot Applicable
Disease Management Programs OfferedAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization100%
Formulary IDWIF005
Formulary URLURL
HIOS Product ID37833WI051
Import Date4/28/2023 4:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment$0.00
Inpatient Copayment Maximum Days0
HSA EligibleNo
New/Existing PlanNew
Notice Required for PregnancyNo
Is a Referral Required for Specialist?No
Issuer Actuarial Value64.78%
Issuer ID37833
Issuer Marketplace Marketing NameQuartz
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelExpanded Bronze
Multiple In Network TiersNo
National NetworkNo
Network IDWIN001
Out of Country CoverageNo
Out of Service Area CoverageYes
Out of Service Area Coverage DescriptionEmergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization
Plan BrochureURL
Plan Effective Date1/1/2023
Plan Expiration Date12/31/2023
Plan ID (Standard Component ID with Variant) 37833WI0510213-00
Plan Marketing NameQUARTZ ONE BRONZE I201
Plan TypeHMO
Plan Variant Marketing NameQUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$0
SBC Scenario, Having a Baby, Copayment$400
SBC Scenario, Having a Baby, Deductible$8,500
SBC Scenario, Having a Baby, Limit$0
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$1,200
SBC Scenario, Having Diabetes, Deductible$0
SBC Scenario, Having Diabetes, Limit$0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance$0
SBC Scenario, Treatment of a Simple Fracture, Copayment$300
SBC Scenario, Treatment of a Simple Fracture, Deductible$2,300
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Service Area IDWIS003
Source NameHIOS
Plan ID37833WI0510213
State CodeWI
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 Coinsurance0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group$18200 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$9100 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$9,100
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$18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person$9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual$9,100
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 QUARTZ ONE BRONZE I201 Health Insurance Plan, 37833WI0510213

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

Frequently Asked Questions(FAQ) about QUARTZ ONE BRONZE I201, 37833WI0510213 Health Insurance Plan, 37833WI0510213

Does QUARTZ ONE BRONZE I201 Health Insurance Plan, 37833WI0510213 support Mail Ordering?

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

Does (37833WI0510213) Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs?

Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

Does (37833WI0510213) Health Insurance Plan, Variant (37833WI0510213-00) have Out Of Country Coverage?

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

Does (37833WI0510213) Health Insurance Plan, Variant (37833WI0510213-00) have Out of Service Area Coverage?

Yes. Details: Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization

Does (37833WI0510213) Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs?

Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

Does QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs for Asthma?

Yes, the QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan Variant 37833WI0510213-00 offers Disease Management Program for Asthma.

Does QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs for Heart disease?

Yes, the QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan Variant 37833WI0510213-00 offers Disease Management Program for Heart disease.

Does QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs for Depression?

Yes, the QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan Variant 37833WI0510213-00 offers Disease Management Program for Depression.

Does QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs for Diabetes?

Yes, the QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan Variant 37833WI0510213-00 offers Disease Management Program for Diabetes.

Does QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs for High blood pressure & high cholesterol?

Yes, the QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan Variant 37833WI0510213-00 offers Disease Management Program for High blood pressure & high cholesterol.

Does QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan, Variant (37833WI0510213-00) offer Disease Management Programs for Pregnancy?

Yes, the QUARTZ ONE BRONZE I201 VALUE TIER RX-SA3 DIRECT Health Insurance Plan Variant 37833WI0510213-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Sun, 01 Oct 2023 10:53 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