Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
EHB Apportionment for Pediatric Dental
1.0
First Tier Utilization
32%
Import Date
2024-08-12 20:01:40
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
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
$25 per person
Medical EHB Deductible, In Network (Tier 1), Individual
$25
Medical EHB Deductible, In Network (Tier 2), Family Per Group
per group not applicable
Medical EHB Deductible, In Network (Tier 2), Family Per Person
$25 per person
Medical EHB Deductible, In Network (Tier 2), Individual
$25
Medical EHB Deductible, Out of Network, Family Per Group
per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person
$225 per person
Medical EHB Deductible, Out of Network, Individual
$225
Plan Effective Date
2025-01-01
Plan Expiration Date
2025-12-31
Plan Level Exclusions
Major Dental Care and Orthodontia - Adult, non-medically necessary orthodontia - Child
QHP/Non QHP
On the Exchange
Second Tier Utilization
68%