| Field | Data |
|---|---|
| Health Insurance Plan ID | 23552TN0020052 |
| Health Insurance Plan Year | 2023 |
| State | Tennessee |
| Health Insurance Issuer | Oscar Insurance Company |
| Last Plan Update Date | Wed, 26 Oct 2022 00:00 GMT |
| Last Import Date | Fri, 31 Mar 2023 05:06 GMT |
| Health Insurance Plan Variant | 23552TN0020052-04 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.73112794 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 73% AV Level Silver Plan |
| Dental Only Plan | No |
| Design Type | Design 1 |
| 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 | 1 |
| First Tier Utilization | 100% |
| Formulary ID | TNF001 |
| Formulary URL | URL |
| HIOS Product ID | 23552TN002 |
| Import Date | 11/18/2022 1:01 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 23552 |
| Issuer Marketplace Marketing Name | Oscar Insurance Company |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | TNN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency and Urgent Services only |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 23552TN0020052-04 |
| Plan Marketing Name | Silver Classic- Standard |
| Plan Type | EPO |
| Plan Variant Marketing Name | Silver Classic- Standard |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,500 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $5,700 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,300 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,200 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | TNS001 |
| Source Name | HIOS |
| Plan ID | 23552TN0020052 |
| State Code | TN |
| 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 | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $11400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $5700 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $5,700 |
| TEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| TEHBDedOutOfNetFamilyPerPerson | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $14400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,200 |
| 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 | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|---|---|---|---|---|---|
| Non preferred brand | 1 month in retail | $80.0 | After deductible | 0% | After deductible | YES |
| Non preferred brand | 3 month in mail | $200.0 | After deductible | 0% | After deductible | YES |
| Non preferred brand | 3 month in retail | $240.0 | After deductible | 0% | After deductible | YES |
| Non preferred generic | 1 month in retail | $20.0 | Before deductible | 0% | Before deductible | YES |
| Non preferred generic | 3 month in mail | $50.0 | Before deductible | 0% | Before deductible | YES |
| Non preferred generic | 3 month in retail | $60.0 | Before deductible | 0% | Before deductible | YES |
| Non preferred specialty drugs | 1 month in retail | $350.0 | After deductible | 0% | After deductible | NO |
| Preferred brand | 1 month in retail | $40.0 | Before deductible | 0% | Before deductible | YES |
| Preferred brand | 3 month in mail | $100.0 | Before deductible | 0% | Before deductible | YES |
| Preferred brand | 3 month in retail | $120.0 | Before deductible | 0% | Before deductible | YES |
| Preferred generic | 1 month in retail | $20.0 | Before deductible | 0% | Before deductible | YES |
| Preferred generic | 3 month in mail | $50.0 | Before deductible | 0% | Before deductible | YES |
| Preferred generic | 3 month in retail | $60.0 | Before deductible | 0% | Before deductible | YES |
| Specialty drugs | 1 month in retail | $350.0 | After deductible | 0% | After deductible | NO |
| Zero cost share preventive drugs | 1 month in retail | $0 | Before deductible | 0% | Before deductible | YES |
| Zero cost share preventive drugs | 3 month in mail | $0 | Before deductible | 0% | Before deductible | YES |
| Zero cost share preventive drugs | 3 month in retail | $0 | Before deductible | 0% | Before deductible | YES |
Frequently Asked Questions(FAQ) about Silver Classic- Standard, 23552TN0020052 Health Insurance Plan, 23552TN0020052
Does Silver Classic- Standard Health Insurance Plan, 23552TN0020052 support Mail Ordering?
Yes, Silver Classic- Standard Health Insurance
Plan, 23552TN0020052 supports mail ordering for the next drug tiers: Non preferred brand, Non preferred generic, Preferred brand, Preferred generic, Zero cost share preventive drugs
What are the Generic Medications coinsurance & copay options with Silver Classic- Standard (23552TN0020052) Health Insurance Plan?
For non preferred generic drug tier copay (Before deductible) is $20.0 and coinsurance (Before deductible) is 0.0%, non preferred generic drug tier copay (Before deductible) is $50.0 and coinsurance (Before deductible) is 0.0%, non preferred generic drug tier copay (Before deductible) is $60.0 and coinsurance (Before deductible) is 0.0%, preferred generic drug tier copay (Before deductible) is $20.0 and coinsurance (Before deductible) is 0.0%, preferred generic drug tier copay (Before deductible) is $50.0 and coinsurance (Before deductible) is 0.0%, preferred generic drug tier copay (Before deductible) is $60.0 and coinsurance (Before deductible) is 0.0%
What are the copay and coinsurance options for Brand Drugs with Silver Classic- Standard Health Insurance Plan (23552TN0020052)?
For non preferred brand drug tier copay (After deductible) is $80.0 and coinsurance (After deductible) is 0.0%, non preferred brand drug tier copay (After deductible) is $200.0 and coinsurance (After deductible) is 0.0%, non preferred brand drug tier copay (After deductible) is $240.0 and coinsurance (After deductible) is 0.0%, preferred brand drug tier copay (Before deductible) is $40.0 and coinsurance (Before deductible) is 0.0%, preferred brand drug tier copay (Before deductible) is $100.0 and coinsurance (Before deductible) is 0.0%, preferred brand drug tier copay (Before deductible) is $120.0 and coinsurance (Before deductible) is 0.0%
What are the copay and coinsurance options for Brand Drugs with Silver Classic- Standard Health Insurance Plan (23552TN0020052)?
, non preferred brand drug tier copay (After deductible) is $80.0 and coinsurance (After deductible) is 0.0%, non preferred brand drug tier copay (After deductible) is $200.0 and coinsurance (After deductible) is 0.0%, non preferred brand drug tier copay (After deductible) is $240.0 and coinsurance (After deductible) is 0.0%, preferred brand drug tier copay (Before deductible) is $40.0 and coinsurance (Before deductible) is 0.0%, preferred brand drug tier copay (Before deductible) is $100.0 and coinsurance (Before deductible) is 0.0%, preferred brand drug tier copay (Before deductible) is $120.0 and coinsurance (Before deductible) is 0.0%
Does (23552TN0020052) Health Insurance Plan, Variant (23552TN0020052-04) 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 (23552TN0020052) Health Insurance Plan, Variant (23552TN0020052-04) have Out Of Country Coverage?
Yes. Details: Emergency Services Only
Does (23552TN0020052) Health Insurance Plan, Variant (23552TN0020052-04) have Out of Service Area Coverage?
Yes. Details: Emergency and Urgent Services only
Does (23552TN0020052) Health Insurance Plan, Variant (23552TN0020052-04) 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- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Asthma?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Asthma.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Heart disease?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Heart disease.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Depression?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Depression.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Diabetes?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Diabetes.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for High blood pressure & high cholesterol.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Low back pain?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Low back pain.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Pain management?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Pain management.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Pregnancy?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Pregnancy.
Does Silver Classic- Standard Health Insurance Plan, Variant (23552TN0020052-04) offer Disease Management Programs for Weight loss programs?
Yes, the Silver Classic- Standard Health Insurance Plan Variant 23552TN0020052-04 offers Disease Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Fri, 31 Mar 2023 05:06 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