Delta Dental Basic Plan - 56891NC0110001 Health Insurance Plan

Delta Dental of North Carolina health insurance plan with the Plan ID 56891NC0110001. The plan is called Delta Dental Basic Plan.

Health Insurance Plan ID 56891NC0110001
Health Insurance Plan Year 2025
State North Carolina
Health Insurance Issuer Delta Dental of North Carolina
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 56891NC0110001-00
Provider Network(s) DELTA-DENTAL-PPO-AND-DELTA-DENTAL-PREMIER
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT).

Providers North Carolina All US States
All 3236 3769
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 2290 2595
Available Variants of the Health Plan

Standard Off Exchange Plan - 56891NC0110001-00

Standard On Exchange Plan - 56891NC0110001-01

Last Plan Update Date Fri, 11 Oct 2024 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Benefits of Delta Dental Basic Plan Health Insurance Plan, 56891NC0110001-00

Benefit Covered In Network Out Of Network
Accidental Dental
NO
Basic Dental Care - Adult

Exclusions: Subject to annual max

6 month wait

YES

Tier 1: No Charge, 50.00% Coinsurance after deductible

Tier 2: No Charge, 60.00% Coinsurance after deductible

No Charge, 60.00% Coinsurance after deductible
Basic Dental Care - Child

Age and frequency mirror benchmark

YES

Tier 1: No Charge, 50.00% Coinsurance after deductible

Tier 2: No Charge, 50.00% Coinsurance after deductible

No Charge, 50.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Benefit Period

Age and frequency mirror benchmark

YES

Tier 1: No Charge, 0.00% Coinsurance after deductible

Tier 2: No Charge, 0.00% Coinsurance after deductible

No Charge, 0.00% Coinsurance after deductible
Major Dental Care - Adult
NO
Major Dental Care - Child

Age and frequency mirror benchmark

YES

Tier 1: No Charge, 50.00% Coinsurance after deductible

Tier 2: No Charge, 50.00% Coinsurance after deductible

No Charge, 50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child
YES

Tier 1: No Charge, 50.00% Coinsurance after deductible

Tier 2: No Charge, 50.00% Coinsurance after deductible

No Charge, 50.00% Coinsurance after deductible
Routine Dental Services (Adult)

Exclusions: Subject to $1,000 annual maximum

YES

Tier 1: No Charge, 0.00% Coinsurance after deductible

Tier 2: No Charge, 20.00% Coinsurance after deductible

No Charge, 20.00% Coinsurance after deductible

Delta Dental Basic Plan Health Insurance Plan Variant 56891NC0110001-00 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 Low Off Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1.0
First Tier Utilization 25%
HIOS Product ID 56891NC011
Import Date 2024-10-11 01:02:00
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 56891
Issuer Marketplace Marketing Name Delta Dental of North Carolina
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 $225 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person $75 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $75
Medical EHB Deductible, In Network (Tier 1), Family Per Group $225 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $75 per person
Medical EHB Deductible, In Network (Tier 1), Individual $75
Medical EHB Deductible, In Network (Tier 2), Family Per Group $225 per group
Medical EHB Deductible, In Network (Tier 2), Family Per Person $75 per person
Medical EHB Deductible, In Network (Tier 2), Individual $75
Medical EHB Deductible, Out of Network, Family Per Group $225 per group
Medical EHB Deductible, Out of Network, Family Per Person $75 per person
Medical EHB Deductible, Out of Network, Individual $75
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, In Network (Tier 2), Family Per Group $750 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person $375 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), 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 Yes
National Network Yes
Network ID NCN001
Out of Country Coverage Yes
Out of Country Coverage Description Benefits paid at out of network level
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Same benefit level
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 56891NC0110001-00
Plan Marketing Name Delta Dental Basic Plan
Plan Type PPO
Plan Variant Marketing Name Delta Dental Basic Plan
QHP/Non QHP Both
Second Tier Utilization 75%
Service Area ID NCS001
Source Name HIOS
Plan ID 56891NC0110001
State Code NC
URL for Enrollment Payment URL

Copay & Coinsurance of Delta Dental Basic Plan Health Insurance Plan, 56891NC0110001

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Delta Dental Basic Plan, 56891NC0110001 Health Insurance Plan, 56891NC0110001

  • Does Delta Dental Basic Plan Health Insurance Plan, 56891NC0110001 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (56891NC0110001) Health Insurance Plan, Variant (56891NC0110001-00) have Out Of Country Coverage?

    Yes. Details: Benefits paid at out of network level

    Does (56891NC0110001) Health Insurance Plan, Variant (56891NC0110001-00) have Out of Service Area Coverage?

    Yes. Details: Same benefit level

 

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