| Field | Data |
|---|---|
| Health Insurance Plan ID | 45480OK0050015 |
| Health Insurance Plan Year | 2023 |
| State | Oklahoma |
| Health Insurance Issuer | UnitedHealthcare of Oklahoma, Inc. |
| Plan Formulary Description URL | Formulary URL |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Fri, 05 Aug 2022 00:00 GMT |
| Last Import Date | Tue, 21 Mar 2023 13:10 GMT |
| Health Insurance Plan Variant | 45480OK0050015-03 |
| Available Variants of the Health Plan | |
| 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 | Limited Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 100% |
| Formulary ID | OKF006 |
| Formulary URL | URL |
| HIOS Product ID | 45480OK005 |
| Import Date | 8/17/2022 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? | No |
| Issuer Actuarial Value | 70.08% |
| Issuer ID | 45480 |
| 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 | OKN001 |
| 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) | 45480OK0050015-03 |
| Plan Level Exclusions | 0 |
| Plan Marketing Name | UHC Silver Value $3,400 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals) |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC Silver-B Value $3,400 Indiv Ded ($0 Virtual Urgent Care + $0 PCP Visits, $3 Generic Rx Pref Pharm, No Referrals) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $3,800 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $3,400 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $400 |
| SBC Scenario, Having Diabetes, Deductible | $3,400 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $100 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | OKS001 |
| Source Name | HIOS |
| Plan ID | 45480OK0050015 |
| State Code | OK |
| 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 | $6800 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $3400 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,400 |
| TEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| TEHBDedOutOfNetFamilyPerPerson | 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 |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|---|---|---|---|---|---|
| Non preferred brand | 1 month in retail | $0 | After deductible | 40.0% | No charge | YES |
| Non preferred generic | 1 month in retail | $30.0 | Before deductible | 0% | No charge | YES |
| Preferred brand | 1 month in retail | $60.0 | After deductible | 0% | No charge | YES |
| Preferred generic | 1 month in retail | $3.0 | Before deductible | 0% | No charge | YES |
| Specialty | 1 month in retail | $0 | After deductible | 50.0% | After deductible | NO |
| Zero cost share preventive | 1 month in retail | $0 | No charge | 0% | No charge | NO |
Frequently Asked Questions(FAQ) about UHC Silver Value $3,400 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals), 45480OK0050015 Health Insurance Plan, 45480OK0050015
Does UHC Silver Value $3,400 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals) Health Insurance Plan, 45480OK0050015 support Mail Ordering?
Yes, UHC Silver Value $3,400 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals) Health Insurance
Plan, 45480OK0050015 supports mail ordering for the next drug tiers: Non preferred brand, Non preferred generic, Preferred brand, Preferred generic
What are the Generic Medications coinsurance & copay options with UHC Silver Value $3,400 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals) (45480OK0050015) Health Insurance Plan?
For non preferred generic drug tier copay (Before deductible) is $30.0 and coinsurance (No charge) is 0.0%, preferred generic drug tier copay (Before deductible) is $3.0 and coinsurance (No charge) is 0.0%
What are the copay and coinsurance options for Brand Drugs with UHC Silver Value $3,400 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals) Health Insurance Plan (45480OK0050015)?
For non preferred brand drug tier copay (After deductible) is $0.0 and coinsurance (No charge) is 40.0%, preferred brand drug tier copay (After deductible) is $60.0 and coinsurance (No charge) is 0.0%
What are the copay and coinsurance options for Brand Drugs with UHC Silver Value $3,400 Deductible (Unlimited $0 Virtual Urgent Care + $0 Primary Care Visits, $3 T1 Preferred Rx, No Referrals) Health Insurance Plan (45480OK0050015)?
, non preferred brand drug tier copay (After deductible) is $0.0 and coinsurance (No charge) is 40.0%, preferred brand drug tier copay (After deductible) is $60.0 and coinsurance (No charge) is 0.0%
Does (45480OK0050015) Health Insurance Plan, Variant (45480OK0050015-03) have Out Of Country Coverage?
No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).
Does (45480OK0050015) Health Insurance Plan, Variant (45480OK0050015-03) 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: Tue, 21 Mar 2023 13:10 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