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Silver Classic - 77739MI0070006 Health Insurance Plan

Oscar Insurance Company health insurance plan with the Plan ID 77739MI0070006. The plan is called Silver Classic.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.06% (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 29.94% 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 ID77739MI0070006
Health Insurance Plan Year2023
StateMichigan
Health Insurance IssuerOscar Insurance Company
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateTue, 28 Feb 2023 00:00 GMT
Last Import DateSun, 24 Sep 2023 09:34 GMT
Health Insurance Plan Variant77739MI0070006-01
 
Available Variants of the Health Plan

77739MI0070006-00

77739MI0070006-01

77739MI0070006-02

77739MI0070006-03

77739MI0070006-04

77739MI0070006-05

77739MI0070006-06

Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 Attributes

Plan Attribute Value
AV Calculator Output Number0.700573248
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 Silver On Exchange Plan
Dental Only PlanNo
Design TypeNot Applicable
Disease Management Programs OfferedAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
EHB Percent of Total Premium 1
First Tier Utilization20%
Formulary IDMIF001
Formulary URLURL
HIOS Product ID77739MI007
Import Date2/28/2023 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 ID77739
Issuer Marketplace Marketing NameOscar Insurance Company
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelSilver
Multiple In Network TiersYes
National NetworkNo
Network IDMIN001
Out of Country CoverageYes
Out of Country Coverage DescriptionEmergency Services Only
Out of Service Area CoverageYes
Out of Service Area Coverage DescriptionEmergency and Urgent Services only
Plan BrochureURL
Plan Effective Date1/1/2023
Plan Expiration Date12/31/2023
Plan ID (Standard Component ID with Variant) 77739MI0070006-01
Plan Marketing NameSilver Classic
Plan TypeEPO
Plan Variant Marketing NameSilver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers)
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$2,300
SBC Scenario, Having a Baby, Copayment$300
SBC Scenario, Having a Baby, Deductible$5,400
SBC Scenario, Having a Baby, Limit$0
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$2,000
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$500
SBC Scenario, Treatment of a Simple Fracture, Deductible$2,100
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Second Tier Utilization80%
Service Area IDMIS001
Source NameSERFF
Plan ID77739MI0070006
State CodeMI
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 Coinsurance50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group$10800 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$5400 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$5,400
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group$10800 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person$5400 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual$5,400
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$17300 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person$8650 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual$8,650
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group$17300 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person$8650 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual$8,650
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 DesignNo
URL for Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program OfferedNo

Copay & Coinsurance of Silver Classic Health Insurance Plan, 77739MI0070006

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

Frequently Asked Questions(FAQ) about Silver Classic, 77739MI0070006 Health Insurance Plan, 77739MI0070006

Does Silver Classic Health Insurance Plan, 77739MI0070006 support Mail Ordering?

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

Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-01) 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, Weight Loss Programs

Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-01) have Out Of Country Coverage?

Yes. Details: Emergency Services Only

Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-01) have Out of Service Area Coverage?

Yes. Details: Emergency and Urgent Services only

Does (77739MI0070006) Health Insurance Plan, Variant (77739MI0070006-01) 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, Weight Loss Programs

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Asthma?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Asthma.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Heart disease?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Heart disease.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Depression?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Depression.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Diabetes?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Diabetes.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for High blood pressure & high cholesterol?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for High blood pressure & high cholesterol.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Low back pain?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Low back pain.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Pain management?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Pain management.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Pregnancy?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Pregnancy.

Does Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan, Variant (77739MI0070006-01) offer Disease Management Programs for Weight loss programs?

Yes, the Silver Classic ($3 Preferred Generic Drugs + $0 Virtual Urgent Care Visits with Select Providers) Health Insurance Plan Variant 77739MI0070006-01 offers Disease Management Program for Weight loss programs.

 

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