Delta Dental of North Carolina health insurance plan with the Plan ID 56891NC0060007. The plan is called Delta Dental Group Pediatric Only: EHB Certified.
Health Insurance Plan ID | 56891NC0060007 | ||||||||||||||||||
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Health Insurance Plan Year | 2022 | ||||||||||||||||||
State | North Carolina | ||||||||||||||||||
Health Insurance Issuer | Delta Dental of North Carolina | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 56891NC0060007-00 | ||||||||||||||||||
Provider Network(s) | ['NCN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 14 May 2024 06:16 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Wed, 16 Jun 2021 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 14 May 2024 06:16 GMT |
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 | 2022 |
Child-Only Offering | Allows Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard High Off Exchange Plan |
Dental Only Plan | Yes |
First Tier Utilization | 25% |
HIOS Product ID | 56891NC006 |
Import Date | 6/16/2021 13:07 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Estimated Rate |
New/Existing Plan | Existing |
Issuer ID | 56891 |
Issuer Marketplace Marketing Name | Delta Dental of North Carolina |
Market Coverage | SHOP (Small Group) |
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 | $150 per group |
Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $50 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $50 |
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, In Network (Tier 2), Family Per Group | per group not applicable |
Medical EHB Deductible, In Network (Tier 2), Family Per Person | per person not applicable |
Medical EHB Deductible, In Network (Tier 2), 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 | $700 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $350 per person |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $350 |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Group | $700 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person | $350 per person |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Individual | $350 |
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 | High |
Multiple In Network Tiers | Yes |
National Network | Yes |
Network ID | NCN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Beneftis Paid at Out of Network Level |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Same Benefit Level |
Plan Effective Date | 1/1/2022 |
Plan Expiration Date | 12/31/2022 |
Plan ID (Standard Component ID with Variant) | 56891NC0060007-00 |
Plan Marketing Name | Delta Dental Group Pediatric Only: EHB Certified |
Plan Type | PPO |
Plan Variant Marketing Name | Delta Dental Group Pediatric Only: EHB Certified |
QHP/Non QHP | Off the Exchange |
Second Tier Utilization | 75% |
Service Area ID | NCS001 |
Source Name | HIOS |
Plan ID | 56891NC0060007 |
State Code | NC |
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, 14 May 2024 06:16 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