UHC Gold Value+ ($2 Rx) - 42529IL0070009 Health Insurance Plan

UnitedHealthcare of Illinois, Inc. health insurance plan with the Plan ID 42529IL0070009. The plan is called UHC Gold Value+ ($2 Rx).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 76.10% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 23.90% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 42529IL0070009
Health Insurance Plan Year 2022
State Illinois
Health Insurance Issuer UnitedHealthcare of Illinois, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 42529IL0070009-00
Provider Network(s) ['ILN001']
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 Illinois 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 - 42529IL0070009-00

Standard On Exchange Plan - 42529IL0070009-01

Open to Indians below 300% FPL - 42529IL0070009-02

Open to Indians above 300% FPL - 42529IL0070009-03

Last Plan Update Date Thu, 18 Nov 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

UHC Gold-X Value+ ($2 Rx) Health Insurance Plan Variant 42529IL0070009-00 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 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold Off Exchange Plan
Dental Only Plan No
EHB Percent of Total Premium 0.9981
First Tier Utilization 100%
Formulary ID ILF004
Formulary URL URL
HIOS Product ID 42529IL007
Import Date 11/18/2021 20:01
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? Yes
Issuer Actuarial Value 76.10%
Issuer ID 42529
Issuer Marketplace Marketing Name UnitedHealthcare
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID ILN001
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 1/1/2022
Plan ID (Standard Component ID with Variant) 42529IL0070009-00
Plan Level Exclusions 0
Plan Marketing Name UHC Gold Value+ ($2 Rx)
Plan Type HMO
Plan Variant Marketing Name UHC Gold-X Value+ ($2 Rx)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,100
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $2,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $20
SBC Scenario, Having Diabetes, Copayment $500
SBC Scenario, Having Diabetes, Deductible $2,500
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $20
SBC Scenario, Treatment of a Simple Fracture, Copayment $80
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID ILS001
Source Name SERFF
Specialist Requiring a Referral All, except OBGYN and as state mandated
Plan ID 42529IL0070009
State Code IL
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 25.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $5000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $2500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $2,500
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 $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 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 Gold Value+ ($2 Rx) Health Insurance Plan, 42529IL0070009

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

Frequently Asked Questions(FAQ) about UHC Gold Value+ ($2 Rx), 42529IL0070009 Health Insurance Plan, 42529IL0070009

  • Does UHC Gold Value+ ($2 Rx) Health Insurance Plan, 42529IL0070009 support Mail Ordering?

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

  • Does (42529IL0070009) Health Insurance Plan, Variant (42529IL0070009-00) have Out Of Country Coverage?

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

    Does (42529IL0070009) Health Insurance Plan, Variant (42529IL0070009-00) 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