Delta Dental PPO Plus Premier-Federally Compliant Plan - 77760OK0020006 Health Insurance Plan

Delta Dental of Oklahoma health insurance plan with the Plan ID 77760OK0020006. The plan is called Delta Dental PPO Plus Premier-Federally Compliant Plan.

Health Insurance Plan ID 77760OK0020006
Health Insurance Plan Year 2025
State Oklahoma
Health Insurance Issuer Delta Dental of Oklahoma
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 77760OK0020006-00
Provider Network(s) ['OKN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Oklahoma 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 - 77760OK0020006-00

Last Plan Update Date Tue, 06 Aug 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan, 77760OK0020006-00

Benefit Covered In Network Out Of Network
Accidental Dental
NO
Basic Dental Care - Adult

Exclusions: Deductible applies. For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.

Deductible applies. For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.

YES

No Charge after deductible, 40.00% Coinsurance after deductible

No Charge after deductible, 40.00% Coinsurance after deductible
Basic Dental Care - Child

Exclusions: Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19.

Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19.

YES

No Charge after deductible, 40.00% Coinsurance after deductible

No Charge after deductible, 40.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

Exclusions: Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19.

Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19.

YES

No Charge after deductible, No Charge after deductible

No Charge after deductible, No Charge after deductible
Major Dental Care - Adult

Exclusions: Deductible applies. For covered persons over the age 18 there is a 12 month waiting period on Class III - Major services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.

Deductible applies. For covered persons over the age 18 there is a 12 month waiting period on Class III - Major services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.

YES

No Charge after deductible, 50.00% Coinsurance after deductible

No Charge after deductible, 50.00% Coinsurance after deductible
Major Dental Care - Child

Exclusions: Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19.

Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19.

YES

No Charge after deductible, 50.00% Coinsurance after deductible

No Charge after deductible, 50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child

Exclusions: Applies to medically necessary procedures only. MOOP only applies to covered persons through the end of the month in which they turn 19.

Applies to medically necessary procedures only. MOOP only applies to covered persons through the end of the month in which they turn 19.

YES

No Charge, 50.00%

No Charge, 50.00%
Routine Dental Services (Adult)

Limit: 1.0 Visit(s) per 6 Months

Exclusions: Deductible applies. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.

Deductible applies. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.

YES

No Charge after deductible, No Charge after deductible

No Charge after deductible, No Charge after deductible

Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan Variant 77760OK0020006-00 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 Low Off Exchange Plan
Dental Only Plan Yes
First Tier Utilization 100%
HIOS Product ID 77760OK002
Import Date 2024-08-06 01:01:33
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 77760
Issuer Marketplace Marketing Name Delta Dental of Oklahoma
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 per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Group per group not applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Person $75 per person
Medical EHB Deductible, In Network (Tier 1), Individual $75
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person $75 per person
Medical EHB Deductible, Out of Network, Individual $75
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, 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 Low
Multiple In Network Tiers No
National Network Yes
Network ID OKN001
Out of Country Coverage Yes
Out of Country Coverage Description All benefits that are offered on the plan are available out of country.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description All benefits that are offered on the plan are available out of the service area.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 77760OK0020006-00
Plan Level Exclusions For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services and a 12 month waiting period on Class III - Major services. MOOP only applies to covered persons age 0 through 18.
Plan Marketing Name Delta Dental PPO Plus Premier-Federally Compliant Plan
Plan Type PPO
Plan Variant Marketing Name Delta Dental PPO Plus Premier-Federally Compliant Plan
QHP/Non QHP Off the Exchange
Service Area ID OKS001
Source Name HIOS
Plan ID 77760OK0020006
State Code OK
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan, 77760OK0020006

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

Frequently Asked Questions(FAQ) about Delta Dental PPO Plus Premier-Federally Compliant Plan, 77760OK0020006 Health Insurance Plan, 77760OK0020006

  • Does Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan, 77760OK0020006 support Mail Ordering?

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

  • Does (77760OK0020006) Health Insurance Plan, Variant (77760OK0020006-00) have Out Of Country Coverage?

    Yes. Details: All benefits that are offered on the plan are available out of country.

    Does (77760OK0020006) Health Insurance Plan, Variant (77760OK0020006-00) have Out of Service Area Coverage?

    Yes. Details: All benefits that are offered on the plan are available out of the service area.

 

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