Anthem Dental Family Value - 16064VA1270005 Health Insurance Plan
Anthem Health Plans of VA, Inc. health insurance plan with the Plan ID 16064VA1270005. The plan is called Anthem Dental Family Value.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.00% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 16064VA1270005 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Virginia | ||||||||||||||||||
| Health Insurance Issuer | Anthem Health Plans of VA, Inc. | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 16064VA1270005-01 | ||||||||||||||||||
| Provider Network(s) | ['VAN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 15 Aug 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 30 Apr 2024 06:06 GMT |
Benefits of Anthem Dental Family Value Health Insurance Plan, 16064VA1270005-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
Limited to the Pediatric Essential Health Benefits only. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Basic Dental Care - Adult
$750.00 Annual Benefit Maximum for all benefits after $50 deductible. 6 Month Waiting period |
YES | 50.00% Coinsurance after deductible |
75.00% Coinsurance after deductible |
| Basic Dental Care - Child
Benefit limitations may apply to individual services. |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year 2 Visits per Year |
YES | No Charge after deductible |
30.00% Coinsurance after deductible |
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
Benefit limitations may apply to individual services. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Limit: 1.0 Treatment(s) per Lifetime Dentally Necessary Coverage Only. Limit applies to one comprehensive orthodontic treatment of the adolescent dentition. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
$750 Annual Benefit Maximum for all adult benefits after $50 deductible. |
YES | No Charge after deductible |
50.00% Coinsurance after deductible |
Anthem Dental Family Value Health Insurance Plan Variant 16064VA1270005-01 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 Low On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1 |
| First Tier Utilization | 100% |
| HIOS Product ID | 16064VA127 |
| Import Date | 8/15/2022 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer Actuarial Value | 70.00% |
| Issuer ID | 16064 |
| 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 | $50 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $50 |
| 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 | Low |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | VAN001 |
| 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 | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 16064VA1270005-01 |
| Plan Level Exclusions | Annual Benefit Maximum (applies to Adult Dental Benefits): $750 |
| Plan Marketing Name | Anthem Dental Family Value |
| Plan Type | PPO |
| Plan Variant Marketing Name | Anthem Dental Family Value |
| QHP/Non QHP | On the Exchange |
| Service Area ID | VAS003 |
| Source Name | SERFF |
| Plan ID | 16064VA1270005 |
| State Code | VA |
Copay & Coinsurance of Anthem Dental Family Value Health Insurance Plan, 16064VA1270005
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Anthem Dental Family Value, 16064VA1270005 Health Insurance Plan, 16064VA1270005
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Does Anthem Dental Family Value Health Insurance Plan, 16064VA1270005 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (16064VA1270005) Health Insurance Plan, Variant (16064VA1270005-01) have Out Of Country Coverage?
Does (16064VA1270005) Health Insurance Plan, Variant (16064VA1270005-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 30 Apr 2024 06:06 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