Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
EHB Apportionment for Pediatric Dental
100%
First Tier Utilization
100%
Guaranteed Rate
Guaranteed Rate
Medical EHB Deductible, Combined In/Out of Network, Family
per person not applicable | per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual
$50
Medical EHB Deductible, In Network (Tier 1), Family
per person not applicable | per group not applicable
Medical EHB Deductible, In Network (Tier 1), Individual
Not Applicable
Medical EHB Deductible, Out of Network, Family
per person not applicable | per group not applicable
Medical EHB Deductible, Out of Network, Individual
Not Applicable
Plan Effective Date
1/1/2025
Plan Expiration Date
12/31/2025
Wellness Program Offered
No