Northeast Delta Dental offers this marketplace health insurance plan (Plan ID 87701NH0100001) 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 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in New Hampshire). 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 On 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).
Variant 87701NH0100001-01 (Standard On Exchange Plan) currently displayed.
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Benefits
Covered services & limitations
Pregnancy & family
Maternity, newborn, pediatric dental and vision extras.
Basic Dental Care - Child
$30.00 Copay after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network$30.00 Copay after deductible, 40.00% Coinsurance after deductible
Out-of-network$30.00 Copay after deductible, 40.00% Coinsurance after deductible
Periodontal maintenance 4 times in 12 months; periodontal scaling and root planing once in 2 years; restorations once in 2 years per tooth; resin restorations on anterior teeth and the buccal surface of bicuspids only; anesthesia only in conjunction with covered services; stainless steel crowns once in 2 years per tooth.
Exclusions: For more details, please refer to the Outline of Benefits and your plan documents
Major Dental Care - Child
$30.00 Copay after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network$30.00 Copay after deductible, 50.00% Coinsurance after deductible
Out-of-network$30.00 Copay after deductible, 50.00% Coinsurance after deductible
Root canal therapy once in 2 years; inlays, onlays and crowns over age 12 once in 5 years; dentures once in 5 years; periodontal surgery once in 3 years; implants over age 16 once in 5 years; occlusal guards over age 13 once in 12 months.
Exclusions: For more details, please refer to the Outline of Benefits and your plan documents
Issuer did not share extra notes for this benefit beyond the summary above.
Basic Dental Care - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Dental Check-Up for Children
$30.00, 0.00%
Tier 1 in-network$30.00, 0.00%
Out-of-network$30.00, 0.00%
Limit: 1.0 Visit(s) per 6 Months
Cleanings once in 6 months, evaluations once in 6 months, bitewing images once in 6 months; comprehensive series or panoramic image once in 5 years; full mouth debridement once in a lifetime; fluoride treatments twice in 12 months; sealants once in 3 years on permanent, un-restored molars; space maintainers once in a lifetime.
Exclusions: For more details, please refer to the Outline of Benefits and your plan documents
Major Dental Care - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
No Charge, 50.00%
Tier 1 in-networkNo Charge, 50.00%
Out-of-networkNo Charge, 50.00%
Subject to medical necessity
Exclusions: For more details, please refer to the Outline of Benefits and your plan documents
Routine Dental Services (Adult)
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Variant attributes
Delta Dental Pediatric Low Plan · Variant 87701NH0100001-01
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
EHB Apportionment for Pediatric Dental
1
First Tier Utilization
100%
Import Date
10/15/2025
Guaranteed Rate
Guaranteed Rate
New/Existing Plan
Existing
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
$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
$150 per person
Medical EHB Deductible, In Network (Tier 1), Individual
$150
Medical EHB Deductible, Out of Network, Family Per Group
per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person
$150 per person
Medical EHB Deductible, Out of Network, Individual
$150
Plan Effective Date
1/1/2026
Plan Expiration Date
12/31/2026
Plan Level Exclusions
Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, tissue conditioning, crowns, inlays, onlays, dentures, implants, and root canal therapy, are subject to age, time, and frequency limitations. Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization. Medically necessary orthodontia is a covered benefit for pediatric enrollees only. Certain covered services apply to treatment for specified teeth. Certain procedures performed on the same date by the same dentist are not separately chargeable by the dentist. Certain covered services are considered part of the complete treatment and not separately chargeable by the dentist. Many dental repairs, replacements, and retreatments are time limited and not separately chargeable by the dentist. Other exclusions and limitations may apply. Please refer to your Policy for details.
Plan Type
PPO
QHP/Non QHP
On the Exchange
Source Name
SERFF
Plan ID
87701NH0100001
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 New Hampshire?
Delta Dental Pediatric Low Plan (87701NH0100001) is a Low PPO from Northeast Delta Dental in New Hampshire for the 2026 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 Pediatric Low Plan 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 Pediatric Low Plan 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 Pediatric Low Plan 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 Pediatric Low Plan?
Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Same Coverage
Does Delta Dental Pediatric Low Plan 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 Coverage
How do I enroll in or manage payments for Delta Dental Pediatric Low Plan?
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.
