BlueCare Dental 4 Kids℠ 1B - 87571OK0390004 Health Insurance Plan
Blue Cross Blue Shield of Oklahoma health insurance plan with the Plan ID 87571OK0390004. The plan is called BlueCare Dental 4 Kids℠ 1B.
| Health Insurance Plan ID | 87571OK0390004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Oklahoma | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross Blue Shield of Oklahoma | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 87571OK0390004-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 11 Nov 2025 05:33 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Sat, 11 Jan 2025 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 11 Nov 2025 05:33 GMT |
Benefits of BlueCare Dental 4 Kids℠ 1B Health Insurance Plan, 87571OK0390004-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year Exclusions: nan nan |
YES | 20.00% |
40.00% |
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan nan |
YES | 50.00% |
70.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO |
BlueCare Dental 4 Kids℠ 1B Health Insurance Plan Variant 87571OK0390004-00 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 Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1.0 |
| First Tier Utilization | 100% |
| HIOS Product ID | 87571OK039 |
| Import Date | 2025-01-11 00:01:52 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 87571 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Oklahoma |
| 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 | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $150 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $50 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $50 |
| Medical EHB Deductible, Out of Network, Family Per Group | $150 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $50 per person |
| Medical EHB Deductible, Out of Network, Individual | $50 |
| 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 | Low |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | OKN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Services out of the country will be treated as Out-of-Network and member will have to pay the provider and file for reimbursement as an Out-of-Network claim. |
| 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 Dental Network partners within our BlueCare Dental Network. In some instances, you may obtain care from Non-Participating Providers. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 87571OK0390004-00 |
| Plan Marketing Name | BlueCare Dental 4 Kids℠ 1B |
| Plan Type | PPO |
| Plan Variant Marketing Name | BlueCare Dental 4 Kids℠ 1B |
| QHP/Non QHP | Both |
| Service Area ID | OKS001 |
| Source Name | HIOS |
| Plan ID | 87571OK0390004 |
| State Code | OK |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of BlueCare Dental 4 Kids℠ 1B Health Insurance Plan, 87571OK0390004
| 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, 87571OK0390004 Health Insurance Plan, 87571OK0390004
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Does BlueCare Dental 4 Kids℠ 1B Health Insurance Plan, 87571OK0390004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (87571OK0390004) Health Insurance Plan, Variant (87571OK0390004-00) have Out Of Country Coverage?
Does (87571OK0390004) Health Insurance Plan, Variant (87571OK0390004-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 11 Nov 2025 05:33 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