UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx) - 97560MS0030027 Health Insurance Plan

UnitedHealthcare of Mississippi, Inc. health insurance plan with the Plan ID 97560MS0030027. The plan is called UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 61.09% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 38.91% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 97560MS0030027
Health Insurance Plan Year 2023
State Mississippi
Health Insurance Issuer UnitedHealthcare of Mississippi, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 97560MS0030027-00
Provider Network(s) ['MSN001']
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 Mississippi 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 - 97560MS0030027-00

Standard On Exchange Plan - 97560MS0030027-01

Open to Indians below 300% FPL - 97560MS0030027-02

Open to Indians above 300% FPL - 97560MS0030027-03

Last Plan Update Date Wed, 01 Mar 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx) Health Insurance Plan, 97560MS0030027-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental

Limit: 3000.0 Dollars per Year

Limited to $3,000 per year.

YES

50% Coinsurance after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

50% Coinsurance after deductible

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child

Benefit limitations may apply to individual services.

YES

50% Coinsurance after deductible

100.00%
Chemotherapy
YES

50% Coinsurance after deductible

100.00%
Chiropractic Care

Limit: 20.0 Visit(s) per Year

Limited to 20 visits for any combination of manipulative treatment, physical therapy and occupational therapy.

YES

50% Coinsurance after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Childbirth/delivery professional services follow inpatient physician/surgeon fees

YES

50% Coinsurance after deductible

100.00%
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

YES

No Charge

100.00%
Diabetes Education
YES

50% Coinsurance after deductible

100.00%
Dialysis
YES

50% Coinsurance after deductible

100.00%
Durable Medical Equipment
YES

50% Coinsurance after deductible

100.00%
Emergency Room Services
YES

50% Coinsurance after deductible

50% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

50% Coinsurance after deductible

50% Coinsurance after deductible
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

50% Coinsurance after deductible

100.00%
Gender Affirming Care
NO
Generic Drugs

Limit: 30.0 Days per Month

Lowest cost shares are available at preferred retail pharmacies and home delivery. See SBC for cost shares at other retail pharmacies and for non-preferred generics. 90-day supplies are available through preferred retail pharmacies or home delivery. Limited to 30 day supplies at all other pharmacies. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. See SBC for non-preferred generic cost shares. Generic medications are available in 90-day supplies through home delivery. Limited to 30 day supplies at all other pharmacies. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

$3.00

100.00%
Habilitation Services
YES

50% Coinsurance after deductible

100.00%
Hearing Aids
NO
Home Health Care Services
YES

50% Coinsurance after deductible

100.00%
Hospice Services
YES

50% Coinsurance after deductible

100.00%
Imaging (CT/PET Scans, MRIs)
YES

50% Coinsurance after deductible

100.00%
Infertility Treatment
NO
Infusion Therapy
YES

50% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

50% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

50% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services

Limit: 18.0 Visit(s) per Year

Limited to 18 Presumptive Drug Tests per year. Limited to 18 Definitive Drug Tests per year.

YES

50% Coinsurance after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child

Benefit limitations may apply to individual services.

YES

50% Coinsurance after deductible

100.00%
Mental/Behavioral Health Inpatient Services
YES

50% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

$75 Copay after deductible

100.00%
Non-Preferred Brand Drugs

Limit: 30.0 Days per Month

Non-preferred brand medications are available in 90-day supplies through preferred retail pharmacies or home delivery. Limited to 30 day supplies at all other pharmacies. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. Non-preferred brand medications are available in 90-day supplies through home delivery. Limited to 30 day supplies at all other pharmacies. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

50% Coinsurance after deductible

100.00%
Nutritional Counseling

This exclusion also does not apply to medical or behavioral/mental health related nutritional education services that are provided as part of treatment for a disease by appropriately licensed or registered health care professionals when both of the following are true: Nutritional education is required for a disease in which patient self-management is a part of treatment. There is a lack of knowledge regarding the disease which requires the help of a trained health professional.

NO
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

50% Coinsurance after deductible

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

50% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 40.0 Visit(s) per Year

Limited to 20 visits per year for speech therapy, and 20 visits for any combination of manipulative treatment, physical therapy and occupational therapy.

YES

50% Coinsurance after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

50% Coinsurance after deductible

100.00%
Preferred Brand Drugs

Limit: 30.0 Days per Month

Preferred brand medications are available in 90-day supplies through preferred retail pharmacies or home delivery. Limited to 30 day supplies at all other pharmacies. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. Preferred brand medications are available in 90-day supplies through home delivery. Limited to 30 day supplies at all other pharmacies. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

YES

50% Coinsurance after deductible

100.00%
Prenatal and Postnatal Care
YES

No Charge

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

$40 Copay after deductible

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

50% Coinsurance after deductible

100.00%
Radiation
YES

50% Coinsurance after deductible

100.00%
Reconstructive Surgery
YES

50% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 20.0 Visit(s) per Year

Limited to 20 visits for any combination of physical therapy and occupational therapy.

YES

50% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 20.0 Visit(s) per Year

YES

50% Coinsurance after deductible

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

YES

No Charge

100.00%
Routine Foot Care

Preventive foot care due to conditions associated with metabolic, neurologic, or peripheral vascular disease

YES

50% Coinsurance after deductible

100.00%
Skilled Nursing Facility
NO
Specialist Visit
YES

$75 Copay after deductible

100.00%
Specialty Drugs

Limit: 30.0 Days per Month

Covers outpatient self-administered prescription legend drugs from a participating network pharmacy. Quantity limits per prescription may apply.

YES

50% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

50% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

$75 Copay after deductible

100.00%
Transplant
YES

50% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders
YES

50% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities
YES

$75 Copay after deductible

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

50% Coinsurance after deductible

100.00%

UHC Bronze-X Essential $6,350 Deductible ($3 T1 Preferred Rx) Health Insurance Plan Variant 97560MS0030027-00 Attributes

Plan Attribute Value
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 Bronze Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID MSF006
Formulary URL URL
HIOS Product ID 97560MS003
Import Date 3/1/2023 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 Actuarial Value 61.09%
Issuer ID 97560
Issuer Marketplace Marketing Name UnitedHealthcare
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Bronze
Multiple In Network Tiers No
National Network No
Network ID MSN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 97560MS0030027-00
Plan Marketing Name UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx)
Plan Type HMO
Plan Variant Marketing Name UHC Bronze-X Essential $6,350 Deductible ($3 T1 Preferred Rx)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,400
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $6,300
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,300
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MSS001
Source Name HIOS
Plan ID 97560MS0030027
State Code MS
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 $12700 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $6350 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $6,350
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person 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 $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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

Copay & Coinsurance of UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx) Health Insurance Plan, 97560MS0030027

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

Frequently Asked Questions(FAQ) about UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx), 97560MS0030027 Health Insurance Plan, 97560MS0030027

  • Does UHC Bronze Essential $6,350 Deductible ($3 T1 Preferred Rx) Health Insurance Plan, 97560MS0030027 support Mail Ordering?

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

  • Does (97560MS0030027) Health Insurance Plan, Variant (97560MS0030027-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (97560MS0030027) Health Insurance Plan, Variant (97560MS0030027-00) have Out of Service Area Coverage?

    Yes. Details: Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area

 

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