Robin Oak $1,800 w/Copay P-S Gold - 20173WI0130001 Health Insurance Plan

HealthPartners Insurance Company health insurance plan with the Plan ID 20173WI0130001. The plan is called Robin Oak $1,800 w/Copay P-S Gold.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.81% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.19% 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 77.24% (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 22.76% 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 20173WI0130001
Health Insurance Plan Year 2022
State Wisconsin
Health Insurance Issuer HealthPartners Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 20173WI0130001-01
Provider Network(s) ['WIN002']
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 Wisconsin 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 On Exchange Plan - 20173WI0130001-01

Open to Indians below 300% FPL - 20173WI0130001-02

Open to Indians above 300% FPL - 20173WI0130001-03

Last Plan Update Date Fri, 13 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.772354148
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 Gold On Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 0.9989
First Tier Utilization 100%
Formulary ID WIF002
Formulary URL URL
HIOS Product ID 20173WI013
Import Date 8/13/2021 1:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment 0
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 78.81%
Issuer ID 20173
Issuer Marketplace Marketing Name HealthPartners
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID WIN002
Out of Country Coverage Yes
Out of Country Coverage Description Coverage for emergency services only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Out-of-Network benefits will be applied
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 20173WI0130001-01
Plan Marketing Name Robin Oak $1,800 w/Copay P-S Gold
Plan Type PPO
Plan Variant Marketing Name Robin Oak $1,800 w/Copay P-S Gold
QHP/Non QHP On the Exchange
SBC Scenario, Having a Baby, Coinsurance $2,100
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $1,800
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $600
SBC Scenario, Having Diabetes, Deductible $900
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $100
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID WIS002
Source Name HIOS
Plan ID 20173WI0130001
State Code WI
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
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person 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 20.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $3600 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1800 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,800
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $40000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $20000 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $20,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $16600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8300 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,300
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 Yes

Copay & Coinsurance of Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, 20173WI0130001

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

Frequently Asked Questions(FAQ) about Robin Oak $1,800 w/Copay P-S Gold, 20173WI0130001 Health Insurance Plan, 20173WI0130001

  • Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, 20173WI0130001 support Mail Ordering?

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

  • Does (20173WI0130001) Health Insurance Plan, Variant (20173WI0130001-01) 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

    Does (20173WI0130001) Health Insurance Plan, Variant (20173WI0130001-01) have Out Of Country Coverage?

    Yes. Details: Coverage for emergency services only

    Does (20173WI0130001) Health Insurance Plan, Variant (20173WI0130001-01) have Out of Service Area Coverage?

    Yes. Details: Out-of-Network benefits will be applied

    Does (20173WI0130001) Health Insurance Plan, Variant (20173WI0130001-01) 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

    Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, Variant (20173WI0130001-01) offer Disease Management Programs for Asthma?

    Yes, the Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 offers Disease Management Program for Asthma.

    Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, Variant (20173WI0130001-01) offer Disease Management Programs for Heart disease?

    Yes, the Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 offers Disease Management Program for Heart disease.

    Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, Variant (20173WI0130001-01) offer Disease Management Programs for Depression?

    Yes, the Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 offers Disease Management Program for Depression.

    Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, Variant (20173WI0130001-01) offer Disease Management Programs for Diabetes?

    Yes, the Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 offers Disease Management Program for Diabetes.

    Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, Variant (20173WI0130001-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, Variant (20173WI0130001-01) offer Disease Management Programs for Low back pain?

    Yes, the Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 offers Disease Management Program for Low back pain.

    Does Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan, Variant (20173WI0130001-01) offer Disease Management Programs for Pregnancy?

    Yes, the Robin Oak $1,800 w/Copay P-S Gold Health Insurance Plan Variant 20173WI0130001-01 offers Disease Management Program for Pregnancy.

 

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