Delta Dental Group Pediatric-Only, EHB Certified · 86728OH0300002
Delta Dental of Ohio offers this marketplace health insurance plan (Plan ID 86728OH0300002) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.
Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Ohio). Submit changes before the deadline to avoid a coverage gap.
Enroll by Dec 15 for Jan 1 starts.
Finalize plan switches before the window closes.
Special Enrollment Periods
You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).
Report the event within 60 days.
Keep documentation handy for Healthcare.gov or your state exchange.
CSR & subsidy reminders
Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.
Enter accurate income to maximize Advanced Premium Tax Credits.
Standard Low Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.
Thinking about switching?
Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.
Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.
Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.
Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).
All providers in OhioN/A
PCPs in OhioN/A
Telehealth supportData pending
Nationwide providersN/A
N/A doctors statewideN/A PCPsN/A OB/GYN
Provider network(s)
['OHN002']
Providers
Ohio
All US states
All
N/A
N/A
PCP
N/A
N/A
Allergy
N/A
N/A
OB/GYN
N/A
N/A
Dentists
N/A
N/A
Drug coverage overview
0 drugs tracked
Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.
Prior authorization
Drugs
Required
0
Not Required
0
Step therapy
Drugs
Required
0
Not Required
0
Quantity limits
Drugs
Has Limit
0
No Limit
0
Customer highlights
What stands out for members
Issuer: Delta Dental of Ohio · Plan ID 86728OH0300002 · 2025 filing.
Variant 86728OH0300002-00 (Standard Off Exchange Plan) currently displayed.
Use the cards on this page to explore network stats, drug coverage, and cost-sharing details.
Advertisement
Benefits
Covered services & limitations
Pregnancy & family
Maternity, newborn, pediatric dental and vision extras.
Basic Dental Care - Child
50.00% Coinsurance after deductible
Tier 1 in-network50.00% Coinsurance after deductible
Tier 2 in-network50.00% Coinsurance after deductible
Out-of-network50.00% Coinsurance after deductible
nan
Exclusions: nan
Major Dental Care - Child
50.00% Coinsurance after deductible
Tier 1 in-network50.00% Coinsurance after deductible
Tier 2 in-network50.00% Coinsurance after deductible
Delta Dental Group Pediatric-Only, EHB Certified · Variant 86728OH0300002-00
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2025
CSR Variation Type
Standard Low Off Exchange Plan
HIOS Product ID
86728OH030
Metal Level
Low
Plan ID (Standard Component ID with Variant)
86728OH0300002-00
Plan Marketing Name
Delta Dental Group Pediatric-Only, EHB Certified
Plan Variant Marketing Name
Delta Dental Group Pediatric-Only, EHB Certified
Issuer & service area
Issuer-provided metadata for this variant.
Issuer Actuarial Value
69.98%
Issuer ID
86728
Issuer Marketplace Marketing Name
Delta Dental of Ohio
Market Coverage
SHOP (Small Group)
Multiple In Network Tiers
Yes
National Network
Yes
Network ID
OHN002
Out of Country Coverage
Yes
Out of Country Coverage Description
Benefits paid at the Out of Network Level
Out of Service Area Coverage
Yes
Out of Service Area Coverage Description
Same Benefit Level
Service Area ID
OHS002
State Code
OH
Cost sharing & actuarial values
Issuer-provided metadata for this variant.
Begin Primary Care Deductible Coinsurance After Number Of Copays
0
Inpatient Copayment Maximum Days
0
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
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, In Network (Tier 2), Family Per Group
$850 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person
$425 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), 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
Additional attributes
Issuer-provided metadata for this variant.
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
First Tier Utilization
25%
Import Date
2024-08-05 20:01:34
Guaranteed Rate
Guaranteed Rate
New/Existing Plan
Existing
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
Plan Effective Date
2025-01-01
Plan Type
PPO
QHP/Non QHP
Off the Exchange
Second Tier Utilization
75%
Source Name
SERFF
Plan ID
86728OH0300002
Copay & coinsurance
Pharmacy cost sharing by tier
Drug tier
Pharmacy type
Copay amount
Copay option
Coinsurance rate
Coinsurance option
Mail order
Questions & answers
Frequently asked questions
How do I choose the right ACA plan in Ohio?
Delta Dental Group Pediatric-Only, EHB Certified (86728OH0300002) is a Low PPO from Delta Dental of Ohio in Ohio for the 2025 coverage year.
Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.
Does Delta Dental Group Pediatric-Only, EHB Certified support telehealth or virtual urgent care?
The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.
Is Delta Dental Group Pediatric-Only, EHB Certified HSA-eligible and does it include dental or vision coverage?
HSA eligibility is not published; check the Summary of Benefits or ask the issuer.
Dental add-ons: Child.
Vision coverage is not listed for this plan.
Does Delta Dental Group Pediatric-Only, EHB Certified support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Is there out-of-country coverage for Delta Dental Group Pediatric-Only, EHB Certified?
Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Benefits paid at the Out of Network Level
Does Delta Dental Group Pediatric-Only, EHB Certified cover care outside the service area?
Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Same Benefit Level
How do I enroll in or manage payments for Delta Dental Group Pediatric-Only, EHB Certified?
Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.
Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
