| Field | Data |
|---|---|
| Health Insurance Plan ID | 13877AZ0070045 |
| Health Insurance Plan Year | 2023 |
| State | Arizona |
| Health Insurance Issuer | Oscar Health Plan, Inc. |
| Last Plan Update Date | Wed, 26 Oct 2022 00:00 GMT |
| Last Import Date | Sun, 28 May 2023 07:51 GMT |
| Health Insurance Plan Variant | 13877AZ0070045-00 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.70093858 |
| 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 | Standard Silver Off Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| 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 | 20% |
| Formulary ID | AZF001 |
| Formulary URL | URL |
| HIOS Product ID | 13877AZ007 |
| Import Date | 4/4/2023 4:01 |
| 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 | 70.23% |
| Issuer ID | 13877 |
| Issuer Marketplace Marketing Name | Oscar Health Plan, Inc. |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | AZN001 |
| 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) | 13877AZ0070045-00 |
| Plan Marketing Name | Silver Simple- For Diabetes |
| Plan Type | HMO |
| Plan Variant Marketing Name | Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,900 |
| SBC Scenario, Having a Baby, Copayment | $200 |
| SBC Scenario, Having a Baby, Deductible | $6,450 |
| SBC Scenario, Having a Baby, Limit | $0 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $200 |
| SBC Scenario, Having Diabetes, Deductible | $4,200 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $80 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,600 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 80% |
| Service Area ID | AZS001 |
| Source Name | HIOS |
| Plan ID | 13877AZ0070045 |
| State Code | AZ |
| 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 | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $12900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $6450 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $6,450 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $12900 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $6450 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $6,450 |
| 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 | $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), In Network (Tier 2), Family Per Group | $17100 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $8550 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), 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 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 |
|---|
Frequently Asked Questions(FAQ) about Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams), 13877AZ0070045 Health Insurance Plan, 13877AZ0070045
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, 13877AZ0070045 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (13877AZ0070045) Health Insurance Plan, Variant (13877AZ0070045-00) 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 (13877AZ0070045) Health Insurance Plan, Variant (13877AZ0070045-00) have Out Of Country Coverage?
Yes. Details: Emergency Services only.
Does (13877AZ0070045) Health Insurance Plan, Variant (13877AZ0070045-00) have Out of Service Area Coverage?
Yes. Details: Emergency and Urgent Services only.
Does (13877AZ0070045) Health Insurance Plan, Variant (13877AZ0070045-00) 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 Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Asthma?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Asthma.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Heart disease?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Heart disease.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Depression?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Depression.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Diabetes?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Diabetes.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for High blood pressure & high cholesterol.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Low back pain?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Low back pain.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Pain management?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Pain management.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Pregnancy?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Pregnancy.
Does Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan, Variant (13877AZ0070045-00) offer Disease Management Programs for Weight loss programs?
Yes, the Silver Simple- For Diabetes ($0 Diabetic Labs + $100 Monthly Cap for Formulary Insulin + $0 Diabetic Foot and Eye Exams) Health Insurance Plan Variant 13877AZ0070045-00 offers Disease Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Sun, 28 May 2023 07:51 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