SimplyBlue 60 - 37160ND2410023 Health Insurance Plan

Blue Cross Blue Shield of North Dakota health insurance plan with the Plan ID 37160ND2410023. The plan is called SimplyBlue 60.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 62.58% (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 37.42% 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 37160ND2410023
Health Insurance Plan Year 2022
State North Dakota
Health Insurance Issuer Blue Cross Blue Shield of North Dakota
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 37160ND2410023-01
Provider Network(s) ['NDN002']
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 North Dakota 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 Off Exchange Plan - 37160ND2410023-00

Standard On Exchange Plan - 37160ND2410023-01

Open to Indians below 300% FPL - 37160ND2410023-02

Open to Indians above 300% FPL - 37160ND2410023-03

Last Plan Update Date Tue, 01 Feb 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

SimplyBlue 60 Health Insurance Plan Variant 37160ND2410023-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.625775909
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 1
Business Year 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Bronze On Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID NDF004
Formulary URL URL
HIOS Product ID 37160ND241
Import Date 2/1/2022 1:00
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 ID 37160
Issuer Marketplace Marketing Name Blue Cross Blue Shield of North Dakota
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Expanded Bronze
Multiple In Network Tiers No
National Network Yes
Network ID NDN002
Out of Country Coverage Yes
Out of Country Coverage Description Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 37160ND2410023-01
Plan Marketing Name SimplyBlue 60
Plan Type PPO
Plan Variant Marketing Name SimplyBlue 60
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,900
SBC Scenario, Having a Baby, Copayment $20
SBC Scenario, Having a Baby, Deductible $6,800
SBC Scenario, Having a Baby, Limit $20
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $300
SBC Scenario, Having Diabetes, Deductible $1,000
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $50
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,700
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID NDS001
Source Name HIOS
Plan ID 37160ND2410023
State Code ND
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $52200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $26100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $26,100
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $40800 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $20400 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $20,400
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 $13600 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $6800 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,800
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $27200 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $13600 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $13,600
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $34800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $17400 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $17,400
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered Yes

Copay & Coinsurance of SimplyBlue 60 Health Insurance Plan, 37160ND2410023

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

Frequently Asked Questions(FAQ) about SimplyBlue 60, 37160ND2410023 Health Insurance Plan, 37160ND2410023

  • Does SimplyBlue 60 Health Insurance Plan, 37160ND2410023 support Mail Ordering?

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

  • Does (37160ND2410023) Health Insurance Plan, Variant (37160ND2410023-01) offer Disease Management Programs?

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

    Does (37160ND2410023) Health Insurance Plan, Variant (37160ND2410023-01) have Out Of Country Coverage?

    Yes. Details: Medical assistance for Emergency Services (including locating a doctor or hospital) outside the BlueCard service area, the Member should call the BlueCard Worldwide Service Center at 1-800-810-BLUE (2583) or call collect at 1-804-673-1177, 24 hours a day, seven days a week. An assistance coordinator, working with a medical professional, can arrange a physician appointment or hospitalization, if necessary.

    Does (37160ND2410023) Health Insurance Plan, Variant (37160ND2410023-01) have Out of Service Area Coverage?

    Yes. Details: Whenever a member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the BlueCard PPO Network.

    Does (37160ND2410023) Health Insurance Plan, Variant (37160ND2410023-01) offer Disease Management Programs?

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

    Does SimplyBlue 60 Health Insurance Plan, Variant (37160ND2410023-01) offer Disease Management Programs for Asthma?

    Yes, the SimplyBlue 60 Health Insurance Plan Variant 37160ND2410023-01 offers Disease Management Program for Asthma.

    Does SimplyBlue 60 Health Insurance Plan, Variant (37160ND2410023-01) offer Disease Management Programs for Heart disease?

    Yes, the SimplyBlue 60 Health Insurance Plan Variant 37160ND2410023-01 offers Disease Management Program for Heart disease.

    Does SimplyBlue 60 Health Insurance Plan, Variant (37160ND2410023-01) offer Disease Management Programs for Diabetes?

    Yes, the SimplyBlue 60 Health Insurance Plan Variant 37160ND2410023-01 offers Disease Management Program for Diabetes.

    Does SimplyBlue 60 Health Insurance Plan, Variant (37160ND2410023-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the SimplyBlue 60 Health Insurance Plan Variant 37160ND2410023-01 offers Disease Management Program for High blood pressure & high cholesterol.

 

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