BlueCare Dental 4 Kids 1B - Low Pediatric Plan - 75605NM0430004 Health Insurance Plan
Blue Cross Blue Shield of New Mexico health insurance plan with the Plan ID 75605NM0430004. The plan is called BlueCare Dental 4 Kids 1B - Low Pediatric Plan.
| Health Insurance Plan ID | 75605NM0430004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New Mexico | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross Blue Shield of New Mexico | ||||||||||||||||||
| Health Insurance Plan Variant | 75605NM0430004-01 | ||||||||||||||||||
| Provider Network(s) | ['NMN004'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Tue, 09 May 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
BlueCare Dental 4 Kids 1B - Low Pediatric Plan Health Insurance Plan Variant 75605NM0430004-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 100% |
| First Tier Utilization | 100% |
| HIOS Product ID | 75605NM043 |
| Import Date | 5/9/2023 |
| Guaranteed Rate | Guaranteed Rate |
| IsItANewPlan | Existing |
| Issuer ID | 75605 |
| Market Coverage | Individual |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family | per person not applicable | per group 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 person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Family | $75 per person | $225 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $75 |
| Medical EHB Deductible, Out of Network, Family | $75 per person | $225 per group |
| Medical EHB Deductible, Out of Network, Individual | $75 |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family | $375 per person | $750 per group |
| 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 person not applicable | per group 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 | NMN004 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers. |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 75605NM0430004-01 |
| Plan Marketing Name | BlueCare Dental 4 Kids 1B - Low Pediatric Plan |
| Plan Type | PPO |
| Plan Variant Marketing Name | BlueCare Dental 4 Kids 1B - Low Pediatric Plan |
| QHP/Non QHP | Both |
| Service Area ID | NMS004 |
| Source Name | SERFF |
| Plan ID | 75605NM0430004 |
| State Code | NM |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of BlueCare Dental 4 Kids 1B - Low Pediatric Plan Health Insurance Plan, 75605NM0430004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about BlueCare Dental 4 Kids 1B - Low Pediatric Plan, 75605NM0430004 Health Insurance Plan, 75605NM0430004
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Does BlueCare Dental 4 Kids 1B - Low Pediatric Plan Health Insurance Plan, 75605NM0430004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (75605NM0430004) Health Insurance Plan, Variant (75605NM0430004-01) have Out Of Country Coverage?
Yes. Details: This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.
Does (75605NM0430004) Health Insurance Plan, Variant (75605NM0430004-01) have Out of Service Area Coverage?
Yes. Details: When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 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