Blue Dental PPO 80/50/50 - 15560MI0720001 Health Insurance Plan
Blue Cross Blue Shield of Michigan Mutual Insurance Company health insurance plan with the Plan ID 15560MI0720001. The plan is called Blue Dental PPO 80/50/50.
| Health Insurance Plan ID | 15560MI0720001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Michigan | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross Blue Shield of Michigan Mutual Insurance Company | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 15560MI0720001-01 | ||||||||||||||||||
| Provider Network(s) | ['MIN003'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 22 Oct 2024 06:47 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 18 Aug 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 22 Oct 2024 06:47 GMT |
Blue Dental PPO 80/50/50 Health Insurance Plan Variant 15560MI0720001-01 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 | 2022 |
| 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 | 15560MI072 |
| Import Date | 8/18/2021 20:00 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 15560 |
| Issuer Marketplace Marketing Name | Blue Cross Blue Shield of Michigan Mutual Insurance Company |
| 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 | $75 per group |
| 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 | $75 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $25 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $25 |
| Medical EHB Deductible, Out of Network, Family Per Group | $75 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $25 per person |
| Medical EHB Deductible, Out of Network, Individual | $25 |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | $725 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 | MIN003 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement. Like PPO network dentists, Blue Par Select dentists accept the Blues’ approved amount as full payment for covered services, less your plan’s deductible or any copay. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan ID (Standard Component ID with Variant) | 15560MI0720001-01 |
| Plan Level Exclusions | $1,200 annual benefit maximum for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. |
| Plan Marketing Name | Blue Dental PPO 80/50/50 |
| Plan Type | PPO |
| Plan Variant Marketing Name | Blue Dental PPO 80/50/50 |
| QHP/Non QHP | Both |
| Service Area ID | MIS004 |
| Source Name | SERFF |
| Plan ID | 15560MI0720001 |
| State Code | MI |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
Copay & Coinsurance of Blue Dental PPO 80/50/50 Health Insurance Plan, 15560MI0720001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Blue Dental PPO 80/50/50, 15560MI0720001 Health Insurance Plan, 15560MI0720001
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Does Blue Dental PPO 80/50/50 Health Insurance Plan, 15560MI0720001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (15560MI0720001) Health Insurance Plan, Variant (15560MI0720001-01) have Out Of Country Coverage?
Does (15560MI0720001) Health Insurance Plan, Variant (15560MI0720001-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 22 Oct 2024 06:47 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