UHC Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) - 42529IL0070013 Health Insurance Plan
UnitedHealthcare of Illinois, Inc. health insurance plan with the Plan ID 42529IL0070013. The plan is called UHC Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.62% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.38% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 42529IL0070013 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| 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 | 42529IL0070013-00 | ||||||||||||||||||
| Provider Network(s) | ['ILN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 42529IL0070013-00 Standard On Exchange Plan - 42529IL0070013-01 Open to Indians below 300% FPL - 42529IL0070013-02 Open to Indians above 300% FPL - 42529IL0070013-03 73% AV Silver Plan - 42529IL0070013-04 |
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| Last Plan Update Date | Wed, 25 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Benefits of UHC Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) Health Insurance Plan, 42529IL0070013-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
YES | 50.00% |
100.00% |
| Accidental Dental
|
YES | 50.00% |
100.00% |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | 50.00% |
100.00% |
| Bariatric Surgery
|
YES | 50.00% |
100.00% |
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
Benefit limitations may apply to individual services. |
YES | 50.00% |
100.00% |
| Chemotherapy
|
YES | 50.00% |
100.00% |
| Chiropractic Care
Limit: 25.0 Visit(s) per Year |
YES | 50.00% |
100.00% |
| Cosmetic Surgery
|
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Childbirth/delivery professional services follow inpatient physician/surgeon fees. |
YES | $2,500.00 |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months |
YES | No Charge |
100.00% |
| Diabetes Education
|
YES | 50.00% |
100.00% |
| Dialysis
|
YES | 50.00% |
100.00% |
| Durable Medical Equipment
|
YES | 50.00% |
100.00% |
| Emergency Room Services
|
YES | $1,000.00 |
$1,000.00 |
| Emergency Transportation/Ambulance
|
YES | 50.00% |
50.00% |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year |
YES | 50.00% |
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. |
YES | $3.00 |
100.00% |
| Habilitation Services
|
YES | $85.00 |
100.00% |
| Hearing Aids
Limit: 1.0 Item(s) per 2 Years Benefits will be provided for hearing aids for children age 18 and under and are limited to one hearing instrument per hearing imparied ear every 24 months. For covered persons age 19 and older, benefits are limited to one hearing instrument per hearing impaired ear every 24 months, up to $2,500 per hearing impaired ear. Benefits for bone anchored hearing aids are covered for all ages and not subject to benefit limit. |
YES | 50.00% |
100.00% |
| Home Health Care Services
|
YES | 50.00% |
100.00% |
| Hospice Services
|
YES | 50.00% |
100.00% |
| Imaging (CT/PET Scans, MRIs)
|
YES | $300.00 |
100.00% |
| Infertility Treatment
Limit: 6.0 Procedure(s) per Lifetime The maximum number of completed oocyte retrievals that are eligible for coverage under this Certificate in your lifetime is six. Following the final completed oocyte retrieval, benefits will be provided for one subsequent procedure to transfer the oocytes or sperm to you.Thereafter, you will have no benefits for infertility treatment. |
YES | 50.00% |
100.00% |
| Infusion Therapy
|
YES | 50.00% |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | $2500 Copay per Day |
100.00% |
| Inpatient Physician and Surgical Services
|
YES | 50.00% |
100.00% |
| Laboratory Outpatient and Professional Services
|
YES | $30.00 |
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 | 50.00% |
100.00% |
| Mental/Behavioral Health Inpatient Services
|
YES | $2500 Copay per Day |
100.00% |
| Mental/Behavioral Health Outpatient Services
|
YES | $85.00 |
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. |
YES | 40% Coinsurance after deductible |
100.00% |
| Nutritional Counseling
|
YES | 50.00% |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Coverage is for medically necessary orthodontia only. |
YES | 50.00% |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | 50.00% |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | $750.00 |
100.00% |
| Outpatient Rehabilitation Services
|
YES | $85.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
|
YES | $750.00 |
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. |
YES | $85 Copay 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
Virtual urgent care visits via a Designated virtual provider unlimited $0 |
YES | No Charge |
100.00% |
| Private-Duty Nursing
Exclusions: Inpatient Private Duty Nursing Service is not covered. Private Duty Nursing services will be covered as a part of the Home Health Care benefit. |
YES | 50.00% |
100.00% |
| Prosthetic Devices
|
YES | 50.00% |
100.00% |
| Radiation
|
YES | 50.00% |
100.00% |
| Reconstructive Surgery
|
YES | 50.00% |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
|
YES | $85.00 |
100.00% |
| Rehabilitative Speech Therapy
|
YES | $85.00 |
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
|
NO | ||
| Skilled Nursing Facility
|
YES | $2500 Copay per Day |
100.00% |
| Specialist Visit
|
YES | $85.00 |
100.00% |
| Specialty Drugs
Limit: 30.0 Days per Month Specialty medications are limited to a 30-day supply. 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% |
| Substance Abuse Disorder Inpatient Services
|
YES | $2500 Copay per Day |
100.00% |
| Substance Abuse Disorder Outpatient Services
|
YES | $85.00 |
100.00% |
| Transplant
|
YES | 50.00% |
100.00% |
| Treatment for Temporomandibular Joint Disorders
|
YES | 50.00% |
100.00% |
| Urgent Care Centers or Facilities
|
YES | $75.00 |
100.00% |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
|
YES | $65.00 |
100.00% |
UHC Silver-X Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) Health Insurance Plan Variant 42529IL0070013-00 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 Silver Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $3000 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $1500 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $1,500 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 0.9981 |
| First Tier Utilization | 100% |
| Formulary ID | ILF008 |
| Formulary URL | URL |
| HIOS Product ID | 42529IL007 |
| Import Date | 1/25/2023 20:01 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 3 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 71.62% |
| Issuer ID | 42529 |
| Issuer Marketplace Marketing Name | UnitedHealthcare |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Silver |
| 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. The Network Area may include select Network providers located in a neighboring state. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 42529IL0070013-00 |
| Plan Level Exclusions | 0 |
| Plan Marketing Name | UHC Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC Silver-X Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $700 |
| SBC Scenario, Having a Baby, Copayment | $5,100 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $70 |
| SBC Scenario, Having Diabetes, Copayment | $900 |
| SBC Scenario, Having Diabetes, Deductible | $1,500 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $1,400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| 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 | 42529IL0070013 |
| 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 |
| 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 Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) Health Insurance Plan, 42529IL0070013
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about UHC Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx), 42529IL0070013 Health Insurance Plan, 42529IL0070013
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Does UHC Silver Advantage 1 (Unlimited Virtual Urgent Care + Primary Care Visits, Preferred Rx) Health Insurance Plan, 42529IL0070013 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (42529IL0070013) Health Insurance Plan, Variant (42529IL0070013-00) have Out Of Country Coverage?
Does (42529IL0070013) Health Insurance Plan, Variant (42529IL0070013-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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