UHC Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) - 43802GA0040034 Health Insurance Plan

UnitedHealthcare of Georgia, Inc. health insurance plan with the Plan ID 43802GA0040034. The plan is called UHC Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.06% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.94% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 43802GA0040034
Health Insurance Plan Year 2023
State Georgia
Health Insurance Issuer UnitedHealthcare of Georgia, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 43802GA0040034-00
Provider Network(s) ['GAN001']
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 Georgia 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 - 43802GA0040034-00

Standard On Exchange Plan - 43802GA0040034-01

Open to Indians below 300% FPL - 43802GA0040034-02

Open to Indians above 300% FPL - 43802GA0040034-03

73% AV Silver Plan - 43802GA0040034-04

87% AV Silver Plan - 43802GA0040034-05

94% AV Silver Plan - 43802GA0040034-06

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

Benefits of UHC Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) Health Insurance Plan, 43802GA0040034-00

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

50% Coinsurance after deductible

100.00%
Acupuncture

Not covered unless the treatment is medically necessary and appropriate and is provided within the scope of the acupuncturist's license; and patient is directed to the acupuncturist for treatment by a licensed physician.

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: 40.0 Visit(s) per Year

Limited to 40 visits for any combination of physical therapy, occupational therapy and speech therapy, audiology, cognitive rehabilitative services, and manipulative treatment. Habilitation and rehabilitation limits are separate.

YES

50% Coinsurance after deductible

100.00%
Cosmetic Surgery

Reconstruction due to bodily injury, infection or other disease of the involved part; or Congenital anomaly of a covered dependent child which resulted in a functional impairment.

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

Limit: 40.0 Visit(s) per Year

Limited to 40 visits for any combination of physical therapy, occupational therapy and speech therapy, audiology, cognitive rehabilitative services, and manipulative treatment. Habilitation and rehabilitation limits are separate.

YES

50% Coinsurance after deductible

100.00%
Hearing Aids
NO
Home Health Care Services

Limit: 120.0 Visit(s) per Year

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

50% Coinsurance 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

40% Coinsurance after deductible

100.00%
Nutritional Counseling
YES

50% Coinsurance after deductible

100.00%
Orthodontia - Adult
NO
Orthodontia - Child

Coverage is for medically necessary orthodontia only.

YES

50% Coinsurance after deductible

100.00%
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 40 visits for any combination of physical therapy, occupational therapy and speech therapy, audiology, cognitive rehabilitative services, and manipulative treatment. Habilitation and rehabilitation limits are separate.

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

$60 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
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: 40.0 Visit(s) per Year

Limited to 40 visits for any combination of physical therapy, occupational therapy and speech therapy, audiology, cognitive rehabilitative services, and manipulative treatment. Habilitation and rehabilitation limits are separate.

YES

50% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 40.0 Visit(s) per Year

Limited to 40 visits for any combination of physical therapy, occupational therapy and speech therapy, audiology, cognitive rehabilitative services, and manipulative treatment. Habilitation and rehabilitation limits are separate.

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
NO
Skilled Nursing Facility

Limit: 60.0 Days per Year

Limit will be any combination of Skilled Nursing Facility or Inpatient Rehabilitation Facility Services.

YES

50% Coinsurance after deductible

100.00%
Specialist Visit
YES

50% Coinsurance 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

50% Coinsurance 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

$75.00

100.00%
Weight Loss Programs

Nutritional counseling for the treatment of obesity, which includes morbid obesity.

YES

50% Coinsurance after deductible

100.00%
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

50% Coinsurance after deductible

100.00%

UHC Silver-X Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) Health Insurance Plan Variant 43802GA0040034-00 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
Dental Only Plan No
Design Type Not Applicable
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID GAF011
Formulary URL URL
HIOS Product ID 43802GA004
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 Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? Yes
Issuer Actuarial Value 70.06%
Issuer ID 43802
Issuer Marketplace Marketing Name UnitedHealthcare
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID GAN001
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) 43802GA0040034-00
Plan Marketing Name UHC Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)
Plan Type HMO
Plan Variant Marketing Name UHC Silver-X Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $4,000
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $3,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $400
SBC Scenario, Having Diabetes, Deductible $3,000
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 $2,700
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID GAS001
Source Name HIOS
Specialist Requiring a Referral All, except OBGYN and as state mandated
Plan ID 43802GA0040034
State Code GA
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 $6000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $3000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $3,000
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 Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) Health Insurance Plan, 43802GA0040034

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

Frequently Asked Questions(FAQ) about UHC Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx), 43802GA0040034 Health Insurance Plan, 43802GA0040034

  • Does UHC Silver Value $3,000 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx) Health Insurance Plan, 43802GA0040034 support Mail Ordering?

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

  • Does (43802GA0040034) Health Insurance Plan, Variant (43802GA0040034-00) have Out Of Country Coverage?

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

    Does (43802GA0040034) Health Insurance Plan, Variant (43802GA0040034-00) 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