Qualified Health Plans in Market

$199 / year

This dataset shows 2018 individual and family health plans available in the United States where the federal government is operating the Marketplace. States not represented in the dataset runs their own Marketplaces.

Complexity

This dataset contains information on certified medical plans offered through an exchange to consumers in the individual market. These plans are also known as Qualified Health Plans (QHPs). The plans offered by the county for states in the Federally-facilitated Exchanges, state partnership exchanges and state-based exchanges using the federal platform for eligibility and enrollment.

Premium amounts do not include tax credits that will lower premiums for many consumers applying for insurance, specifically those with income up to 400 percent of the federal poverty level.

This dataset also indicates whether the medical plan is a standardized plan design. An issuer may have up to five unique plans in each metal level that follow the standardized plan design for that metal level.

The dataset also shows standard cost-sharing information for each plan. Cost-sharing information is shown for in-network services, and includes:
• Deductibles: For in-network medical care and drugs (by individual, family)
• Maximum out-of-pocket expenses: For in-network medical care and drugs (by individual, family)
• Copayments and coinsurance for the following in-network services:
o Primary care physician
o Specialist
o Emergency Room
o Inpatient facility
o Inpatient physician
o Generic drugs
o Preferred brand drugs
o Non-preferred brand drugs
o Specialty drugs

It shows cost-sharing information for silver metal plans that are variants of the standard silver plan. Consumers that qualify for these silver plan variations based on their incomes and family size will see lower out-of-pocket costs. These plans differ from the standard plan by the percentage of healthcare expenses covered by the plan for a typical group of enrollees (i.e., actuarial value). The actuarial values of these silver plan variants are: 73 Percent Silver, 87 Percent Silver and 94 Percent Silver.

Date Created

2016-06-23

Last Modified

2018-07-09

Version

2018-07-09

Update Frequency

Annual

Temporal Coverage

2018-01-01 to 2018-12-31

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Healthcare, Health Insurance, Health Plans, Adults Healthcare Coverage, Age Groups And Healthcare Coverage, Primary Care Physician, Health Plans in Market, Health Premiums, Health Medical Plans

Other Titles

Certified Insurance Medical Plans, Health Insurance Metal Plans in Market

Name Description Type Constraints
State_AbbreviationState abbreviation for which medical plan is offeredstring-
FIPS_CodeFIPS county code is a five-digit Federal Information Processing Standards (FIPS) code which uniquely identifies counties and county equivalents in the United Statesintegerlevel : Nominal
CountyName of the county where health plan is offeredstring-
Metal_LevelCategory of plan level offered (Gold, Silver, Bronze, Catastrophic, Expanded Bronze, Platinum)string-
Issuer_NameName of the insurance company who are offering health plansstring-
HIOS_Issuer_IDThe Health Insurance Oversight System (HIOS) is responsible for collecting issuer general identification information.integerlevel : Nominal
Plan_IDA unique identification number assigned to health planstring-
Plan_Marketing_NameName of the plan in the marketstring-
Plan_TypeType of plan (EPO= Exclusive Provider Organization, HMO= Health Maintenance Organization, PPO= Preferred Provider Organization, POS= Point of service)string-
Standardized_Plan_DesignDifferent Standardized Health Plans with Affordable Upfront Out-of-Pocket Costsstring-
Rating_AreaUnder the Affordable Care Act each state has submitted a plan to divide up the areas of the state into locations called rating areasstring-
Child_Only_OfferingHealth plan offered (Allows Adult and Child-Only, Allows Adult-Only)string-
SourceSource name which uses web-based application softwarestring-
Customer_Service_Phone_Number_LocalPhone number of the local customer service helplinestring-
Customer_Service_Phone_Number_Toll_FreeToll-free service helpline for customersstring-
Customer_Service_Phone_Number_TTYText Phone number which is used mostly by deaf customersstring-
Network_URLWeb link of the health plan offeredstring-
Plan_Brochure_URLBrochure of health plan on Web URLstring-
Summary_of_Benefits_URLSummary benefits for health plan on web URLstring-
Drug_Formulary_URLDrug formulary is a list of prescription drugs, both generic and brand name, used by practitioners to identify drugs that offer the greatest overall valuestring-
AccreditationHealthcare accreditation organizationstring-
Is_Adult_DentalAdult dental coverage in health planboolean-
Is_Child_DentalChild dental coverage in health planboolean-
EHB_Percent_of_Total_PremiumPercentage of Total Premium of Essential Health Benefitsnumberlevel : Ratio
Premium_Child_Age_0_to_14Premium amount for one child from age 0 to 14number-
Premium_Child_Age_18Premium amount for one child age 18number-
Premium_Adult_Individual_Age_21Premium amount for individual adult one child age 21number-
Premium_Adult_Individual_Age_27Premium amount for individual adult one child age 27number-
Premium_Adult_Individual_Age_30Premium amount for individual adult one child age 30number-
Premium_Adult_Individual_Age_40Premium amount for individual adult one child age 40number-
Premium_Adult_Individual_Age_50Premium amount for individual adult one child age 50number-
Premium_Adult_Individual_Age_60Premium amount for individual adult one child age 60number-
Premium_Couple_21Premium amount for couple (two adults, no child) age 21number-
Premium_Couple_30Premium amount for couple (two adults, no child) age 30number-
Premium_Couple_40Premium amount for couple (two adults, no child) age 40number-
Premium_Couple_50Premium amount for couple (two adults, no child) age 50number-
Premium_Couple_60Premium amount for couple (two adults, no child) age 60number-
Couple_Plus_1_Child_Age_21Premium amount for couple (two adults, one child) age 21number-
Couple_Plus_1_Child_Age_30Premium amount for couple (two adults, one child) age 30number-
Couple_Plus_1_Child_Age_40Premium amount for couple (two adults, one child) age 40number-
Couple_Plus_1_Child_Age_50Premium amount for couple (two adults, one child) age 50number-
Couple_Plus_2_Child_Age_21Premium amount for couple (two adults, two children) age 21number-
Couple_Plus_2_Child_Age_30Premium amount for couple (two adults, two children) age 30number-
Couple_Plus_2_Child_Age_40Premium amount for couple (two adults, two children) age 40number-
Couple_Plus_2_Child_Age_50Premium amount for couple (two adults, two children) age 50number-
Couple_Plus_3_Child_Age_21Premium amount for couple (two adults, three or more children) age 21number-
Couple_Plus_3_Child_Age_30Premium amount for couple (two adults, three or more children) age 30number-
Couple_Plus_3_Child_Age_40Premium amount for couple (two adults, three or more children) age 40number-
Couple_Plus_3_Child_Age_50Premium amount for couple (two adults, three or more children) age 50number-
Individual_Plus_1_Child_Age_21Premium amount for individual one child age 21number-
Individual_Plus_1_Child_Age_30Premium amount for individual one child age 30number-
Individual_Plus_1_Child_Age_40Premium amount for individual one child age 40number-
Individual_Plus_1_Child_Age_50Premium amount for individual one child age 50number-
Individual_Plus_2_Child_Age_21Premium amount for individual two children age 21number-
Individual_Plus_2_Child_Age_30Premium amount for individual two children age 30number-
Individual_Plus_2_Child_Age_40Premium amount for individual two children age 40number-
Individual_Plus_2_Child_Age_50Premium amount for individual two children age 50number-
Individual_Plus_3_Child_Age_21Premium amount for individual three children ore more age 21number-
Individual_Plus_3_Child_Age_30Premium amount for individual three children ore more age 30number-
Individual_Plus_3_Child_Age_40Premium amount for individual three children ore more age 40number-
Individual_Plus_3_Child_Age_50Premium amount for individual three children ore more age 50number-
Medical_Deductible_Individual_StandardDeductible amount for in-network medical care by individual standardnumber-
Drug_Deductible_Individual_StandardDeductible amount for in-network drug care by individual standardstring-
Medical_Deductible_Family_StandardDeductible amount for in-network medical care by family standardnumber-
Drug_Deductible_Family_StandardDeductible amount for in-network drug care by family standardstring-
Medical_Deductible_Family_Per_Person_StandardDeductible amount for in-network medical care by per person standardnumber-
Drug_Deductible_Family_Per_Person_StandardDeductible amount for in-network drug care by per person standardstring-
Medical_Maximum_Out_of_Pocket_Individual_Standardnumber-
Drug_Maximum_Out_of_Pocket_Individual_Standardstring-
Medical_Maximum_Out_of_Pocket_Family_Standardstring-
Drug_Maximum_Out_of_Pocket_Family_Standardstring-
Medical_Maximum_Out_of_Pocket_Family_Per_Person_Standardnumber-
Drug_Maximum_Out_of_Pocket_Family_Per_Person_Standardstring-
Primary_Care_Physician_StandardCopayments and coinsurance for the primary care physicians standard in-network servicesstring-
Specialist_StandardCopayments and coinsurance for the specialist standard in-network servicesstring-
Emergency_Room_StandardCopayments and coinsurance for the emergency room standard in-network servicesstring-
Inpatient_Facility_StandardCopayments and coinsurance for the inpatient facility standard in-network servicesstring-
Inpatient_Physician_StandardCopayments and coinsurance for the inpatient-physician standard in-network servicesstring-
Generic_Drugs_StandardCopayments and coinsurance for the generic drugs standard in-network servicesstring-
Preferred_Brand_Drugs_StandardCopayments and coinsurance for the preferred brand drugs standard in-network servicesstring-
Non_Preferred_Brand_Drugs_StandardCopayments and coinsurance for the non-preferred brand drugs standard in-network servicesstring-
Specialty_Drugs_StandardCopayments and coinsurance for the specialty drugs standard in-network servicesstring-
Medical_Deductible_Individual_73_PercentMedical cost-sharing information for 73 percent silver metal plans that are variants of the individual standard silver plannumber-
Drug_Deductible_Individual_73_PercentDrug cost-sharing information for 73 percent silver metal plans that are variants of the individual standard silver planstring-
Medical_Deductible_Family_73_PercentMedical cost-sharing information for 73 percent silver metal plans that are variants of the family standard silver plannumber-
Drug_Deductible_Family_73_PercentDrug cost-sharing information for 73 percent silver metal plans that are variants of the family standard silver planstring-
Medical_Deductible_Family_Per_Person_73_PercentMedical cost-sharing information for 73 percent silver metal plans that are variants of the per person standard silver plannumber-
Drug_Deductible_Family_Per_Person_73_PercentDrug cost-sharing information for 73 percent silver metal plans that are variants of the per person standard silver planstring-
Medical_Maximum_Out_of_Pocket_Individual_73_Percentnumber-
Drug_Maximum_Out_of_Pocket_Individual_73_Percentstring-
Medical_Maximum_Out_of_Pocket_Family_73_Percentnumber-
Drug_Maximum_Out_of_Pocket_Family_73_Percentstring-
Medical_Maximum_Out_of_Pocket_Family_Per_Person_73_Percentnumber-
Drug_Maximum_Out_of_Pocket_Family_Per_Person_73_Percentstring-
Primary_Care_Physician_73_PercentCopayments and coinsurance for the primary care physicians standard plan 73 percent silverstring-
Specialist_73_PercentCopayments and coinsurance for the specialist standard plan 73 percent silverstring-
Emergency_Room_73_PercentCopayments and coinsurance for the emergency room standard plan 73 percent silverstring-
Inpatient_Facility_73_PercentCopayments and coinsurance for the inpatient facility standard plan 73 percent silverstring-
Inpatient_Physician_73_PercentCopayments and coinsurance for the inpatient-physician standard plan 73 percent silverstring-
Generic_Drugs_73_PercentCopayments and coinsurance for the generic drug standard plan 73 percent silverstring-
Preferred_Brand_Drugs_73_PercentCopayments and coinsurance for the preferred brand drugs plan 73 percent silverstring-
Non_Preferred_Brand_Drugs_73_PercentCopayments and coinsurance for the non-preferred brand drugs plan 73 percent silverstring-
Specialty_Drugs_73_PercentCopayments and coinsurance for the specialty drugs plan 73 percent silverstring-
Medical_Deductible_Individual_87_PercentMedical cost-sharing information for 87 percent silver metal plans that are variants of the individual standard silver plannumber-
Drug_Deductible_Individual_87_PercentDrug cost-sharing information for 87 percent silver metal plans that are variants of the individual standard silver planstring-
Medical_Deductible_Family_87_PercentMedical cost-sharing information for 87 percent silver metal plans that are variants of the family standard silver plannumber-
Drug_Deductible_Family_87_PercentDrug cost-sharing information for 87 percent silver metal plans that are variants of the family standard silver planstring-
Medical_Deductible_Family_Per_Person_87_PercentMedical cost-sharing information for 87 percent silver metal plans that are variants of the per person standard silver plannumber-
Drug_Deductible_Family_Per_Person_87_PercentDrug cost-sharing information for 87 percent silver metal plans that are variants of the per person standard silver planstring-
Medical_Maximum_Out_of_Pocket_Individual_87_Percentnumber-
Drug_Maximum_Out_of_Pocket_Individual_87_Percentstring-
Medical_Maximum_Out_of_Pocket_Family_87_Percentnumber-
Drug_Maximum_Out_of_Pocket_Family_87_Percentstring-
Medical_Maximum_Out_of_Pocket_Family_Per_Person_87_Percentnumber-
Drug_Maximum_Out_of_Pocket_Famil_Per_Person_87_Percentstring-
Primary_Care_Physician_87_PercentCopayments and coinsurance for the primary care physicians standard plan 87 percent silverstring-
Specialist_87_PercentCopayments and coinsurance for the specialist standard plan 87 percent silverstring-
Emergency_Room_87_PercentCopayments and coinsurance for the emergency room standard plan 87 percent silverstring-
Inpatient_Facility_87_PercentCopayments and coinsurance for the inpatient facility standard plan 87 percent silverstring-
Inpatient_Physician_87_PercentCopayments and coinsurance for the inpatient-physician standard plan 87 percent silverstring-
Generic_Drugs_87_PercentCopayments and coinsurance for the generic drug standard plan 87 percent silverstring-
Preferred_Brand_Drugs_87_PercentCopayments and coinsurance for the preferred brand drugs plan 87 percent silverstring-
Non_Preferred_Brand_Drugs_87_PercentCopayments and coinsurance for the non-preferred brand drugs plan 87 percent silverstring-
Specialty_Drugs_87_PercentCopayments and coinsurance for the specialty drugs plan 87 percent silverstring-
Medical_Deductible_Individual_94_PercentMedical cost-sharing information for 94 percent silver metal plans that are variants of the individual standard silver plannumber-
Drug_Deductible_Individual_94_PercentDrug cost-sharing information for 94 percent silver metal plans that are variants of the individual standard silver planstring-
Medical_Deductible_Family_94_PercentMedical cost-sharing information for 94 percent silver metal plans that are variants of the family standard silver plannumber-
Drug_Deductible_Family_94_PercentDrug cost-sharing information for 94 percent silver metal plans that are variants of the family standard silver planstring-
Medical_Deductible_Family_Per_Person_94_PercentMedical cost-sharing information for 94 percent silver metal plans that are variants of the per person standard silver plannumber-
Drug_Deductible_Family_Per_Person_94_PercentDrug cost-sharing information for 94 percent silver metal plans that are variants of the per person standard silver planstring-
Medical_Maximum_Out_of_Pocket_Individual_94_Percentnumber-
Drug_Maximum_Out_of_Pocket_Individual_94_Percentstring-
Medical_Maximum_Out_of_Pocket_Family_94_Percentnumber-
Drug_Maximum_Out_of_Pocket_Family_94_Percentstring-
Medical_Maximum_Out_of_Pocket_Family_Per_Person_94_Percentnumber-
Drug_Maximum_Out_of_Pocket_Family_Per_Person_94_Percentstring-
Primary_Care_Physician_94_PercentCopayments and coinsurance for the primary care physicians standard plan 94 percent silverstring-
Specialist_94_PercentCopayments and coinsurance for the specialist standard plan 94 percent silverstring-
Emergency_Room_94_PercentCopayments and coinsurance for the emergency room standard plan 94 percent silverstring-
Inpatient_Facility_94_PercentCopayments and coinsurance for the inpatient facility standard plan 94 percent silverstring-
Inpatient_Physician_94_PercentCopayments and coinsurance for the inpatient-physician standard plan 94 percent silverstring-
Generic_Drugs_94_PercentCopayments and coinsurance for the generic drug standard plan 94 percent silverstring-
Preferred_Brand_Drugs_94_PercentCopayments and coinsurance for the preferred brand drugs plan 94 percent silverstring-
Non_Preferred_Brand_Drugs_94_PercentCopayments and coinsurance for the non-preferred brand drugs plan 94 percent silverstring-
Specialty_Drugs_94_PercentCopayments and coinsurance for the specialty drugs plan 94 percent silverstring-
State_AbbreviationFIPS_CodeCountyMetal_LevelIssuer_NameHIOS_Issuer_IDPlan_IDPlan_Marketing_NamePlan_TypeStandardized_Plan_DesignRating_AreaChild_Only_OfferingSourceCustomer_Service_Phone_Number_LocalCustomer_Service_Phone_Number_Toll_FreeCustomer_Service_Phone_Number_TTYNetwork_URLPlan_Brochure_URLSummary_of_Benefits_URLDrug_Formulary_URLAccreditationIs_Adult_DentalIs_Child_DentalEHB_Percent_of_Total_PremiumPremium_Child_Age_0_to_14Premium_Child_Age_18Premium_Adult_Individual_Age_21Premium_Adult_Individual_Age_27Premium_Adult_Individual_Age_30Premium_Adult_Individual_Age_40Premium_Adult_Individual_Age_50Premium_Adult_Individual_Age_60Premium_Couple_21Premium_Couple_30Premium_Couple_40Premium_Couple_50Premium_Couple_60Couple_Plus_1_Child_Age_21Couple_Plus_1_Child_Age_30Couple_Plus_1_Child_Age_40Couple_Plus_1_Child_Age_50Couple_Plus_2_Child_Age_21Couple_Plus_2_Child_Age_30Couple_Plus_2_Child_Age_40Couple_Plus_2_Child_Age_50Couple_Plus_3_Child_Age_21Couple_Plus_3_Child_Age_30Couple_Plus_3_Child_Age_40Couple_Plus_3_Child_Age_50Individual_Plus_1_Child_Age_21Individual_Plus_1_Child_Age_30Individual_Plus_1_Child_Age_40Individual_Plus_1_Child_Age_50Individual_Plus_2_Child_Age_21Individual_Plus_2_Child_Age_30Individual_Plus_2_Child_Age_40Individual_Plus_2_Child_Age_50Individual_Plus_3_Child_Age_21Individual_Plus_3_Child_Age_30Individual_Plus_3_Child_Age_40Individual_Plus_3_Child_Age_50Medical_Deductible_Individual_StandardDrug_Deductible_Individual_StandardMedical_Deductible_Family_StandardDrug_Deductible_Family_StandardMedical_Deductible_Family_Per_Person_StandardDrug_Deductible_Family_Per_Person_StandardMedical_Maximum_Out_of_Pocket_Individual_StandardDrug_Maximum_Out_of_Pocket_Individual_StandardMedical_Maximum_Out_of_Pocket_Family_StandardDrug_Maximum_Out_of_Pocket_Family_StandardMedical_Maximum_Out_of_Pocket_Family_Per_Person_StandardDrug_Maximum_Out_of_Pocket_Family_Per_Person_StandardPrimary_Care_Physician_StandardSpecialist_StandardEmergency_Room_StandardInpatient_Facility_StandardInpatient_Physician_StandardGeneric_Drugs_StandardPreferred_Brand_Drugs_StandardNon_Preferred_Brand_Drugs_StandardSpecialty_Drugs_StandardMedical_Deductible_Individual_73_PercentDrug_Deductible_Individual_73_PercentMedical_Deductible_Family_73_PercentDrug_Deductible_Family_73_PercentMedical_Deductible_Family_Per_Person_73_PercentDrug_Deductible_Family_Per_Person_73_PercentMedical_Maximum_Out_of_Pocket_Individual_73_PercentDrug_Maximum_Out_of_Pocket_Individual_73_PercentMedical_Maximum_Out_of_Pocket_Family_73_PercentDrug_Maximum_Out_of_Pocket_Family_73_PercentMedical_Maximum_Out_of_Pocket_Family_Per_Person_73_PercentDrug_Maximum_Out_of_Pocket_Family_Per_Person_73_PercentPrimary_Care_Physician_73_PercentSpecialist_73_PercentEmergency_Room_73_PercentInpatient_Facility_73_PercentInpatient_Physician_73_PercentGeneric_Drugs_73_PercentPreferred_Brand_Drugs_73_PercentNon_Preferred_Brand_Drugs_73_PercentSpecialty_Drugs_73_PercentMedical_Deductible_Individual_87_PercentDrug_Deductible_Individual_87_PercentMedical_Deductible_Family_87_PercentDrug_Deductible_Family_87_PercentMedical_Deductible_Family_Per_Person_87_PercentDrug_Deductible_Family_Per_Person_87_PercentMedical_Maximum_Out_of_Pocket_Individual_87_PercentDrug_Maximum_Out_of_Pocket_Individual_87_PercentMedical_Maximum_Out_of_Pocket_Family_87_PercentDrug_Maximum_Out_of_Pocket_Family_87_PercentMedical_Maximum_Out_of_Pocket_Family_Per_Person_87_PercentDrug_Maximum_Out_of_Pocket_Famil_Per_Person_87_PercentPrimary_Care_Physician_87_PercentSpecialist_87_PercentEmergency_Room_87_PercentInpatient_Facility_87_PercentInpatient_Physician_87_PercentGeneric_Drugs_87_PercentPreferred_Brand_Drugs_87_PercentNon_Preferred_Brand_Drugs_87_PercentSpecialty_Drugs_87_PercentMedical_Deductible_Individual_94_PercentDrug_Deductible_Individual_94_PercentMedical_Deductible_Family_94_PercentDrug_Deductible_Family_94_PercentMedical_Deductible_Family_Per_Person_94_PercentDrug_Deductible_Family_Per_Person_94_PercentMedical_Maximum_Out_of_Pocket_Individual_94_PercentDrug_Maximum_Out_of_Pocket_Individual_94_PercentMedical_Maximum_Out_of_Pocket_Family_94_PercentDrug_Maximum_Out_of_Pocket_Family_94_PercentMedical_Maximum_Out_of_Pocket_Family_Per_Person_94_PercentDrug_Maximum_Out_of_Pocket_Family_Per_Person_94_PercentPrimary_Care_Physician_94_PercentSpecialist_94_PercentEmergency_Room_94_PercentInpatient_Facility_94_PercentInpatient_Physician_94_PercentGeneric_Drugs_94_PercentPreferred_Brand_Drugs_94_PercentNon_Preferred_Brand_Drugs_94_PercentSpecialty_Drugs_94_Percent
HI15009MauiGoldHawaii Medical Service Association1835018350HI0880007HMSA Gold PPOPPONot ApplicableRating Area 1Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-808-948-55551-800-620-46721-877-447-5990http://www.hmsa.com/search/providershttp://www.hmsa.com/sbc/2018/gold-ppo.pdfhttps://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf98.8303.18361.83396.32415.33449.82506.49707.821075.6792.64899.641012.981415.642151.21095.821202.821316.161718.82139915061619.3420221702.181809.181922.522325.18699.5753809.6710111002.681056.181112.851314.181305.861359.361416.031617.360Included in Medical0Included in Medical0Included in Medical7350Included in Medical14700Included in Medical7350Included in Medical3030303030105010020
HI15007KauaiGoldHawaii Medical Service Association1835018350HI0880007HMSA Gold PPOPPONot ApplicableRating Area 1Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-808-948-55551-800-620-46721-877-447-5990http://www.hmsa.com/search/providershttp://www.hmsa.com/sbc/2018/gold-ppo.pdfhttps://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf98.8303.18361.83396.32415.33449.82506.49707.821075.6792.64899.641012.981415.642151.21095.821202.821316.161718.82139915061619.3420221702.181809.181922.522325.18699.5753809.6710111002.681056.181112.851314.181305.861359.361416.031617.360Included in Medical0Included in Medical0Included in Medical7350Included in Medical14700Included in Medical7350Included in Medical3030303030105010020
HI15001HawaiiGoldHawaii Medical Service Association1835018350HI0880007HMSA Gold PPOPPONot ApplicableRating Area 1Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-808-948-55551-800-620-46721-877-447-5990http://www.hmsa.com/search/providershttp://www.hmsa.com/sbc/2018/gold-ppo.pdfhttps://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf98.8303.18361.83396.32415.33449.82506.49707.821075.6792.64899.641012.981415.642151.21095.821202.821316.161718.82139915061619.3420221702.181809.181922.522325.18699.5753809.6710111002.681056.181112.851314.181305.861359.361416.031617.360Included in Medical0Included in Medical0Included in Medical7350Included in Medical14700Included in Medical7350Included in Medical3030303030105010020
HI15003HonoluluGoldHawaii Medical Service Association1835018350HI0880007HMSA Gold PPOPPONot ApplicableRating Area 1Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-808-948-55551-800-620-46721-877-447-5990http://www.hmsa.com/search/providershttp://www.hmsa.com/sbc/2018/gold-ppo.pdfhttps://hmsa.com/portal/provider/HMSA_Metallic_Prescription_Formulary.pdf98.8303.18361.83396.32415.33449.82506.49707.821075.6792.64899.641012.981415.642151.21095.821202.821316.161718.82139915061619.3420221702.181809.181922.522325.18699.5753809.6710111002.681056.181112.851314.181305.861359.361416.031617.360Included in Medical0Included in Medical0Included in Medical7350Included in Medical14700Included in Medical7350Included in Medical3030303030105010020
MI26163WayneGoldTotal Health Care USA, Inc.6718367183MI0030001Total HMO StandardHMONot ApplicableRating Area 1Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-313-871-2000 x3501-800-826-28621-800-649-3777http://providersearch.thcmi.com/http://brochure.thcmi.com/https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-01.pdfhttps://thcmi.com/pharmacy/99.9204.39243.93267.19280303.24341.45477.18725.11534.38606.48682.9954.361450.22738.77810.87887.291158.75943.161015.261091.681363.141147.551219.651296.071567.53471.58507.63545.84681.57675.97712.02750.23885.96880.36916.41954.621090.351000020000100005000Included in Medical10000Included in Medical5000Included in Medical3060350No Charge after DeductibleNo Charge after Deductible255010030
MI26099MacombGoldTotal Health Care USA, Inc.6718367183MI0030001Total HMO StandardHMONot ApplicableRating Area 2Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-313-871-2000 x3501-800-826-28621-800-649-3777http://providersearch.thcmi.com/http://brochure.thcmi.com/https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-01.pdfhttps://thcmi.com/pharmacy/99.9204.39243.93267.19280303.24341.45477.18725.11534.38606.48682.9954.361450.22738.77810.87887.291158.75943.161015.261091.681363.141147.551219.651296.071567.53471.58507.63545.84681.57675.97712.02750.23885.96880.36916.41954.621090.351000020000100005000Included in Medical10000Included in Medical5000Included in Medical3060350No Charge after DeductibleNo Charge after Deductible255010030
MI26049GeneseeGoldTotal Health Care USA, Inc.6718367183MI0030001Total HMO StandardHMONot ApplicableRating Area 5Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-313-871-2000 x3501-800-826-28621-800-649-3777http://providersearch.thcmi.com/http://brochure.thcmi.com/https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-01.pdfhttps://thcmi.com/pharmacy/99.9204.39243.93267.19280303.24341.45477.18725.11534.38606.48682.9954.361450.22738.77810.87887.291158.75943.161015.261091.681363.141147.551219.651296.071567.53471.58507.63545.84681.57675.97712.02750.23885.96880.36916.41954.621090.351000020000100005000Included in Medical10000Included in Medical5000Included in Medical3060350No Charge after DeductibleNo Charge after Deductible255010030
MI26125OaklandGoldTotal Health Care USA, Inc.6718367183MI0030001Total HMO StandardHMONot ApplicableRating Area 2Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-313-871-2000 x3501-800-826-28621-800-649-3777http://providersearch.thcmi.com/http://brochure.thcmi.com/https://thcmi.com/PDF/members/PDF/SBC/2018/67183MI0030001-01.pdfhttps://thcmi.com/pharmacy/99.9204.39243.93267.19280303.24341.45477.18725.11534.38606.48682.9954.361450.22738.77810.87887.291158.75943.161015.261091.681363.141147.551219.651296.071567.53471.58507.63545.84681.57675.97712.02750.23885.96880.36916.41954.621090.351000020000100005000Included in Medical10000Included in Medical5000Included in Medical3060350No Charge after DeductibleNo Charge after Deductible255010030
PA42017BucksGoldKeystone Health Plan East, Inc3387133871PA0040002Keystone HMO GoldHMONot ApplicableRating Area 8Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-844-258-34631-844-258-34631-844-258-3463http://www.ibx.com/individuals/find_provider/index.htmlhttps://www.ibx4you.com/ffm/brochure2018https://www.ibx4you.com/pdfs/ffm/2018/hmogold2018.pdfhttp://www.ibx.com/ffm/formulary5vtrue100381.97455.87499.3523.27566.71638.11891.761355.11998.61133.421276.221783.522710.221380.571515.391658.192165.491762.541897.362040.162547.462144.512279.332422.132929.43881.27948.681020.081273.731263.241330.651402.051655.71645.211712.621784.022037.670000006000Included in Medical12000Included in Medical6000Included in Medical3565350750 Copay per Day2015405050
PA42029ChesterGoldKeystone Health Plan East, Inc3387133871PA0040002Keystone HMO GoldHMONot ApplicableRating Area 8Allows Adult and Child-OnlySystem for Electronic Rate and Form Filing1-844-258-34631-844-258-34631-844-258-3463http://www.ibx.com/individuals/find_provider/index.htmlhttps://www.ibx4you.com/ffm/brochure2018https://www.ibx4you.com/pdfs/ffm/2018/hmogold2018.pdfhttp://www.ibx.com/ffm/formulary5vtrue100381.97455.87499.3523.27566.71638.11891.761355.11998.61133.421276.221783.522710.221380.571515.391658.192165.491762.541897.362040.162547.462144.512279.332422.132929.43881.27948.681020.081273.731263.241330.651402.051655.71645.211712.621784.022037.670000006000Included in Medical12000Included in Medical6000Included in Medical3565350750 Copay per Day2015405050