Oregon Dental Service health insurance plan with the Plan ID 21989AK0100003. The plan is called Delta Dental PPO, PF, 2000, 100/90/50, 50.
Health Insurance Plan ID | 21989AK0100003 | ||||||||||||||||||
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Health Insurance Plan Year | 2025 | ||||||||||||||||||
State | Alaska | ||||||||||||||||||
Health Insurance Issuer | Oregon Dental Service | ||||||||||||||||||
Health Insurance Plan Variant | 21989AK0100003-00 | ||||||||||||||||||
Provider Network(s) | ['AKN002'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Thu, 29 Aug 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 10 Dec 2024 06:32 GMT |
Benefit | Covered | In Network | Out Of Network |
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Accidental Dental
|
NO | ||
Basic Dental Care - Adult
Limit: 2000.0 Dollars per Year |
YES | 10.00% Coinsurance after deductible |
30.00% Coinsurance after deductible |
Basic Dental Care - Child
|
YES | No Charge |
50.00% Coinsurance after deductible |
Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months |
YES | No Charge |
20.00% |
Major Dental Care - Adult
Limit: 2000.0 Dollars per Year |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Major Dental Care - Child
|
YES | No Charge |
50.00% Coinsurance after deductible |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
Only medically necessary orthodontia is covered |
YES | No Charge |
50.00% Coinsurance after deductible |
Routine Dental Services (Adult)
Limit: 2000.0 Dollars per Year |
YES | No Charge |
10.00% |
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 | 2025 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard High Off Exchange Plan |
Dental Only Plan | Yes |
First Tier Utilization | 100% |
HIOS Product ID | 21989AK010 |
Import Date | 2024-08-29 01:02:15 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 21989 |
Issuer Marketplace Marketing Name | Delta Dental of Alaska |
Market Coverage | SHOP (Small Group) |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | $850 per group |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | $425 per person |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $425 |
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, 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 | per group not applicable |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | per person not applicable |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | Not Applicable |
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 | No |
National Network | Yes |
Network ID | AKN002 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Out-of-network benefits |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Out-of-network benefits |
Plan Effective Date | 2025-01-01 |
Plan Expiration Date | 2025-12-31 |
Plan ID (Standard Component ID with Variant) | 21989AK0100003-00 |
Plan Marketing Name | Delta Dental PPO, PF, 2000, 100/90/50, 50 |
Plan Type | PPO |
Plan Variant Marketing Name | Delta Dental PPO, PF, 2000, 100/90/50, 50 |
QHP/Non QHP | Off the Exchange |
Service Area ID | AKS002 |
Source Name | HIOS |
Plan ID | 21989AK0100003 |
State Code | AK |
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, 10 Dec 2024 06:32 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