Cigna Health and Life Insurance Company health insurance plan with the Plan ID 86830AZ0050002. The plan is called Cigna Dental Family + Pediatric.
Health Insurance Plan ID | 86830AZ0050002 | ||||||||||||||||||
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Health Insurance Plan Year | 2025 | ||||||||||||||||||
State | Arizona | ||||||||||||||||||
Health Insurance Issuer | Cigna Health and Life Insurance Company | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 86830AZ0050002-01 | ||||||||||||||||||
Provider Network(s) | PREFERRED | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Thu, 15 Aug 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Benefit | Covered | In Network | Out Of Network |
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Accidental Dental
Child Coverage Only. Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 0.00% |
0.00% |
Accidental Dental Adult
Please refer to Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
Basic Dental Care - Adult
Adult dental benefits are subject to $1000 per person per year maximum for all covered services. Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
Basic Dental Care - Child
Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months Dental Check-up is limited to 1 per 6 consecutive month period. Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 0.00% |
0.00% |
Major Dental Care - Adult
Adult dental benefits are subject to $1000 per person per year maximum for all covered services. Routine Dental Services is limited to 1 per 6 consecutive month period. Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Major Dental Care - Child
Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Orthodontia - Adult
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NO | ||
Orthodontia - Child
Medically necessary only. Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Routine Dental Services (Adult)
Limit: 1.0 Visit(s) per 6 Months Adult dental benefits are subject to $1000 per person per year maximum for all covered services. Routine Dental Services is limited to 1 per 6 consecutive month period. Please refer to the Plan Brochure for detailed services covered, not covered, and frequency limitations. |
YES | 0.00% |
0.00% |
Plan Attribute | Value |
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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 Low On Exchange Plan |
Dental Only Plan | Yes |
EHB Apportionment for Pediatric Dental | 1.0 |
First Tier Utilization | 100% |
HIOS Product ID | 86830AZ005 |
Import Date | 2024-08-15 01:01:23 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 86830 |
Issuer Marketplace Marketing Name | Cigna Healthcare |
Market Coverage | Individual |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | $800 per group |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | $400 per person |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $400 |
Medical EHB Deductible, Combined In/Out of Network, Family Per Group | $300 per group |
Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $150 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $150 |
Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
Medical EHB Deductible, In Network (Tier 1), Family Per Person | per person not applicable |
Medical EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
Medical EHB Deductible, Out of Network, Individual | Not Applicable |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | per group not applicable |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | per person not applicable |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | Not Applicable |
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 | AZN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Emergency Services |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | All Services |
Plan Brochure | URL |
Plan Effective Date | 2025-01-01 |
Plan Expiration Date | 2025-12-31 |
Plan ID (Standard Component ID with Variant) | 86830AZ0050002-01 |
Plan Marketing Name | Cigna Dental Family + Pediatric |
Plan Type | PPO |
Plan Variant Marketing Name | Cigna Dental Family + Pediatric |
QHP/Non QHP | On the Exchange |
Service Area ID | AZS001 |
Source Name | HIOS |
Plan ID | 86830AZ0050002 |
State Code | AZ |
URL for Enrollment Payment | URL |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 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