Anthem Dental Family Enhanced - 17575IN0920004 Health Insurance Plan

Anthem Ins Companies Inc(Anthem BCBS) health insurance plan with the Plan ID 17575IN0920004. The plan is called Anthem Dental Family Enhanced.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 85.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 15.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 17575IN0920004
Health Insurance Plan Year 2025
State Indiana
Health Insurance Issuer Anthem Ins Companies Inc(Anthem BCBS)
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 17575IN0920004-00
Provider Network(s) ['INN007']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Indiana 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 - 17575IN0920004-00

Last Plan Update Date Sat, 02 Nov 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Anthem Dental Family Enhanced Health Insurance Plan, 17575IN0920004-00

Benefit Covered In Network Out Of Network
Accidental Dental
NO
Basic Dental Care - Adult

6 month waiting period

YES

20.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Basic Dental Care - Child
YES

20.00% Coinsurance after deductible

40.00% Coinsurance after deductible
Cosmetic Orthodontia

Limit: 1000.0 Dollars per Lifetime

12 month waiting period- Child Only

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

YES

No Charge after deductible

20.00% Coinsurance after deductible
Major Dental Care - Adult

12 month waiting period

YES

50.00% Coinsurance after deductible

75.00% Coinsurance after deductible
Major Dental Care - Child
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child

Dentally Necessary Orthodontia: No Waiting Period. Cosmetic Orthodontia Coverage: 12 month waiting period with $1000 Lifetime Maximum

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Routine Dental Services (Adult)
YES

No Charge after deductible

50.00% Coinsurance after deductible

Anthem Dental Family Enhanced Health Insurance Plan Variant 17575IN0920004-00 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 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard High Off Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 0.8338
First Tier Utilization 100%
HIOS Product ID 17575IN092
Import Date 2024-11-02 01:02:12
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer Actuarial Value 85.00%
Issuer ID 17575
Issuer Marketplace Marketing Name Anthem Blue Cross and Blue Shield
Market Coverage Individual
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Not Applicable
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 $25 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $25
Medical EHB Deductible, In Network (Tier 1), Family Per Group per group not applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Person per person not applicable
Medical EHB Deductible, In Network (Tier 1), Individual Not Applicable
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
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group $750 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $375 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $375
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual Not Applicable
Metal Level High
Multiple In Network Tiers No
National Network Yes
Network ID INN007
Out of Country Coverage Yes
Out of Country Coverage Description Out of Country covered services are reimbursed as out-of-network benefits.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description If a member does not use a network dentist, services will be reimbursed at the out-of-network level.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 17575IN0920004-00
Plan Marketing Name Anthem Dental Family Enhanced
Plan Type PPO
Plan Variant Marketing Name Anthem Dental Family Enhanced
QHP/Non QHP Off the Exchange
Service Area ID INS019
Source Name HIOS
Plan ID 17575IN0920004
State Code IN
URL for Enrollment Payment URL

Copay & Coinsurance of Anthem Dental Family Enhanced Health Insurance Plan, 17575IN0920004

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

Frequently Asked Questions(FAQ) about Anthem Dental Family Enhanced, 17575IN0920004 Health Insurance Plan, 17575IN0920004

  • Does Anthem Dental Family Enhanced Health Insurance Plan, 17575IN0920004 support Mail Ordering?

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

  • Does (17575IN0920004) Health Insurance Plan, Variant (17575IN0920004-00) have Out Of Country Coverage?

    Yes. Details: Out of Country covered services are reimbursed as out-of-network benefits.

    Does (17575IN0920004) Health Insurance Plan, Variant (17575IN0920004-00) have Out of Service Area Coverage?

    Yes. Details: If a member does not use a network dentist, services will be reimbursed at the out-of-network level.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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