Comprehensive Family Plan - 33086IN0060003 Health Insurance Plan
Health Resources, Inc. health insurance plan with the Plan ID 33086IN0060003. The plan is called Comprehensive Family Plan.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.80% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.20% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 33086IN0060003 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Indiana | ||||||||||||||||||
| Health Insurance Issuer | Health Resources, Inc. | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 33086IN0060003-01 | ||||||||||||||||||
| Provider Network(s) | ['INN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 13 Jul 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 30 Apr 2024 06:06 GMT |
Benefits of Comprehensive Family Plan Health Insurance Plan, 33086IN0060003-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
|
YES | 30.00% Coinsurance after deductible |
100.00% |
| Basic Dental Care - Child
|
YES | 50.00% Coinsurance after deductible |
100.00% |
| Dental Check-Up for Children
Limit: 2.0 Exam(s) per Year Limited to 2 exams and 2 cleanings per year. |
YES | No Charge |
100.00% |
| Major Dental Care - Adult
Crowns are limited to replacement 1 time every 5 years. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Major Dental Care - Child
Filings are limited to replacement 1 time every 2 years. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Limited to Medically Necessary Orthodontia. See detailed information in your benefits summary. |
YES | 50.00% |
100.00% |
| Routine Dental Services (Adult)
Limit: 2.0 Exam(s) per Year Limited to 2 exams and 2 cleanings per year. |
YES | No Charge |
100.00% |
Comprehensive Family Plan Health Insurance Plan Variant 33086IN0060003-01 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 | 2023 |
| 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 | 33086IN006 |
| Import Date | 7/13/2022 1:00 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | New |
| Issuer Actuarial Value | 70.80% |
| Issuer ID | 33086 |
| Issuer Marketplace Marketing Name | Paramount Dental |
| 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 | 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 | $25 |
| 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 | $750 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 | INN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage allowed at any network dentist in United States. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 33086IN0060003-01 |
| Plan Marketing Name | Comprehensive Family Plan |
| Plan Type | HMO |
| Plan Variant Marketing Name | Comprehensive Family Plan |
| QHP/Non QHP | On the Exchange |
| Service Area ID | INS001 |
| Source Name | HIOS |
| Plan ID | 33086IN0060003 |
| State Code | IN |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Comprehensive Family Plan Health Insurance Plan, 33086IN0060003
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Comprehensive Family Plan, 33086IN0060003 Health Insurance Plan, 33086IN0060003
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Does Comprehensive Family Plan Health Insurance Plan, 33086IN0060003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (33086IN0060003) Health Insurance Plan, Variant (33086IN0060003-01) have Out Of Country Coverage?
Does (33086IN0060003) Health Insurance Plan, Variant (33086IN0060003-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 30 Apr 2024 06:06 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