Delta Dental PPO, PF, +3000, 100/90/50, 50 - 21989AK0180002 Health Insurance Plan

Oregon Dental Service health insurance plan with the Plan ID 21989AK0180002. The plan is called Delta Dental PPO, PF, +3000, 100/90/50, 50.

Health Insurance Plan ID

21989AK0180002

Health Insurance Plan Year

2025

State

Alaska

Health Insurance Issuer

Oregon Dental Service

Health Insurance Plan Variant

21989AK0180002-00

Provider Network(s)

['AKN002']

In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 11 Nov 2025 05:33 GMT).

Providers	Alaska	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

Available Variants of the Health Plan

Standard Off Exchange Plan - 21989AK0180002-00

Last Plan Update Date

Thu, 29 Aug 2024 00:00 GMT

Last Import Date

Tue, 11 Nov 2025 05:33 GMT

Benefits of Delta Dental PPO, PF, +3000, 100/90/50, 50 Health Insurance Plan, 21989AK0180002-00

Benefit	Covered	In Network	Out Of Network
Accidental Dental Exclusions: nan nan	NO
Basic Dental Care - Adult Limit: 3000.0 Dollars per Year Exclusions: nan nan	YES	10.00% Coinsurance after deductible	30.00% Coinsurance after deductible
Basic Dental Care - Child Exclusions: nan nan	YES	No Charge	50.00% Coinsurance after deductible
Dental Check-Up for Children Limit: 1.0 Visit(s) per 6 Months Exclusions: nan nan	YES	No Charge	20.00%
Major Dental Care - Adult Limit: 3000.0 Dollars per Year Exclusions: nan nan	YES	50.00% Coinsurance after deductible	50.00% Coinsurance after deductible
Major Dental Care - Child Exclusions: nan nan	YES	No Charge	50.00% Coinsurance after deductible
Orthodontia - Adult Exclusions: nan nan	NO
Orthodontia - Child Exclusions: nan Only medically necessary orthodontia is covered	YES	No Charge	50.00% Coinsurance after deductible
Routine Dental Services (Adult) Limit: 3000.0 Dollars per Year Exclusions: nan nan	YES	No Charge	10.00%

Delta Dental PPO, PF, +3000, 100/90/50, 50 Health Insurance Plan Variant 21989AK0180002-00 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 High Off Exchange Plan
Dental Only Plan	Yes
First Tier Utilization	100%
HIOS Product ID	21989AK018
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)	21989AK0180002-00
Plan Marketing Name	Delta Dental PPO, PF, +3000, 100/90/50, 50
Plan Type	PPO
Plan Variant Marketing Name	Delta Dental PPO, PF, +3000, 100/90/50, 50
QHP/Non QHP	Off the Exchange
Service Area ID	AKS002
Source Name	HIOS
Plan ID	21989AK0180002
State Code	AK

Copay & Coinsurance of Delta Dental PPO, PF, +3000, 100/90/50, 50 Health Insurance Plan, 21989AK0180002

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

Frequently Asked Questions(FAQ) about Delta Dental PPO, PF, +3000, 100/90/50, 50, 21989AK0180002 Health Insurance Plan, 21989AK0180002

Does Delta Dental PPO, PF, +3000, 100/90/50, 50 Health Insurance Plan, 21989AK0180002 support Mail Ordering?

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

Does (21989AK0180002) Health Insurance Plan, Variant (21989AK0180002-00) have Out Of Country Coverage?

Yes. Details: Out-of-network benefits

Does (21989AK0180002) Health Insurance Plan, Variant (21989AK0180002-00) have Out of Service Area Coverage?