Blue Dental PPO Plus 100/80/50/50 Voluntary MAC SG - 15560MI1170001 Health Insurance Plan
Blue Cross Blue Shield of Michigan Mutual Insurance Company health insurance plan with the Plan ID 15560MI1170001. The plan is called Blue Dental PPO Plus 100/80/50/50 Voluntary MAC SG.
| Health Insurance Plan ID | 15560MI1170001 | ||||||||||||||||||
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| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Michigan | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross Blue Shield of Michigan Mutual Insurance Company | ||||||||||||||||||
| Health Insurance Plan Variant | 15560MI1170001-00 | ||||||||||||||||||
| Provider Network(s) | ['MIN003'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 14 Aug 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 13 May 2025 06:05 GMT |
Blue Dental PPO Plus 100/80/50/50 Voluntary MAC SG Health Insurance Plan Variant 15560MI1170001-00 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 |
| First Tier Utilization | 100% |
| HIOS Product ID | 15560MI117 |
| Import Date | 2024-08-14 20:01:41 |
| 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 | SHOP (Small Group) |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | $850 per group |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | $425 per person |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $425 |
| 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 | $850 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $425 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $425 |
| 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 | 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 US can participate in the Tier 2 par per claim Blue Par Select arrangement. Similar to PPO, dentists accept Blue Cross' approved amount for covered services as payment in full, less deductible or any coinsurance. |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 15560MI1170001-00 |
| Plan Level Exclusions | $1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19. |
| Plan Marketing Name | Blue Dental PPO Plus 100/80/50/50 Voluntary MAC SG |
| Plan Type | PPO |
| Plan Variant Marketing Name | Blue Dental PPO Plus 100/80/50/50 Voluntary MAC SG |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | MIS009 |
| Source Name | SERFF |
| Plan ID | 15560MI1170001 |
| State Code | MI |
Copay & Coinsurance of Blue Dental PPO Plus 100/80/50/50 Voluntary MAC SG Health Insurance Plan, 15560MI1170001
| 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 Plus 100/80/50/50 Voluntary MAC SG, 15560MI1170001 Health Insurance Plan, 15560MI1170001
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Does Blue Dental PPO Plus 100/80/50/50 Voluntary MAC SG Health Insurance Plan, 15560MI1170001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (15560MI1170001) Health Insurance Plan, Variant (15560MI1170001-00) have Out Of Country Coverage?
Does (15560MI1170001) Health Insurance Plan, Variant (15560MI1170001-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 13 May 2025 06:05 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