Delta Dental Premier, +1000, 100*/80/50, 50, PF - 21989AK0030052 Health Insurance Plan
Oregon Dental Service health insurance plan with the Plan ID 21989AK0030052. The plan is called Delta Dental Premier, +1000, 100*/80/50, 50, PF.
| Health Insurance Plan ID | 21989AK0030052 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Alaska | ||||||||||||||||||
| Health Insurance Issuer | Oregon Dental Service | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 21989AK0030052-00 | ||||||||||||||||||
| Provider Network(s) | ['AKN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Sat, 19 Nov 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Benefits of Delta Dental Premier, +1000, 100*/80/50, 50, PF Health Insurance Plan, 21989AK0030052-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
YES | 40.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months |
YES | No Charge |
No Charge |
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Only medically necessary orthodontia is covered |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
|
NO |
Delta Dental Premier, +1000, 100*/80/50, 50, PF Health Insurance Plan Variant 21989AK0030052-00 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 | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Child Only Plan ID | No |
| Composite Rating Offered | No |
| CSR Variation Type | Standard High Off Exchange Plan |
| Dental Only Plan | Yes |
| First Tier Utilization | 100% |
| HIOS Product ID | 21989AK003 |
| Import Date | 11/19/2022 1:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Estimated 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 | $750 per group |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | $375 per person |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $375 |
| 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 | AKN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Providers treated as out-of-network. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | National Network |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 21989AK0030052-00 |
| Plan Marketing Name | Delta Dental Premier, +1000, 100*/80/50, 50, PF |
| Plan Type | Indemnity |
| Plan Variant Marketing Name | Delta Dental Premier, +1000, 100*/80/50, 50, PF |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | AKS001 |
| Source Name | HIOS |
| Plan ID | 21989AK0030052 |
| State Code | AK |
| URL for Enrollment Payment | URL |
| Wellness Program Offered | Allows Adult and Child-Only |
Copay & Coinsurance of Delta Dental Premier, +1000, 100*/80/50, 50, PF Health Insurance Plan, 21989AK0030052
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Delta Dental Premier, +1000, 100*/80/50, 50, PF, 21989AK0030052 Health Insurance Plan, 21989AK0030052
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Does Delta Dental Premier, +1000, 100*/80/50, 50, PF Health Insurance Plan, 21989AK0030052 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (21989AK0030052) Health Insurance Plan, Variant (21989AK0030052-00) have Out Of Country Coverage?
Yes. Details: Providers treated as out-of-network.
Does (21989AK0030052) Health Insurance Plan, Variant (21989AK0030052-00) have Out of Service Area Coverage?
Yes. Details: National Network
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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