Delta Dental Premier, +1500, 100/80/50, 50, PF - 21989AK0130003 Health Insurance Plan

Oregon Dental Service health insurance plan with the Plan ID 21989AK0130003. The plan is called Delta Dental Premier, +1500, 100/80/50, 50, PF.

Health Insurance Plan ID 21989AK0130003
Health Insurance Plan Year 2025
State Alaska
Health Insurance Issuer Oregon Dental Service
Health Insurance Plan Variant 21989AK0130003-00
Provider Network(s) ['AKN001']
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 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 - 21989AK0130003-00

Last Plan Update Date Thu, 29 Aug 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Delta Dental Premier, +1500, 100/80/50, 50, PF Health Insurance Plan, 21989AK0130003-00

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

Limit: 1500.0 Dollars per Year

YES

20.00% Coinsurance after deductible

20.00% Coinsurance after deductible
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

Limit: 1500.0 Dollars per Year

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
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)

Limit: 1500.0 Dollars per Year

YES

No Charge

No Charge

Delta Dental Premier, +1500, 100/80/50, 50, PF Health Insurance Plan Variant 21989AK0130003-00 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 21989AK013
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 AKN001
Out of Country Coverage Yes
Out of Country Coverage Description Treated as out-of-network
Out of Service Area Coverage Yes
Out of Service Area Coverage Description National network
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 21989AK0130003-00
Plan Marketing Name Delta Dental Premier, +1500, 100/80/50, 50, PF
Plan Type Indemnity
Plan Variant Marketing Name Delta Dental Premier, +1500, 100/80/50, 50, PF
QHP/Non QHP Off the Exchange
Service Area ID AKS001
Source Name HIOS
Plan ID 21989AK0130003
State Code AK

Copay & Coinsurance of Delta Dental Premier, +1500, 100/80/50, 50, PF Health Insurance Plan, 21989AK0130003

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

Frequently Asked Questions(FAQ) about Delta Dental Premier, +1500, 100/80/50, 50, PF, 21989AK0130003 Health Insurance Plan, 21989AK0130003

  • Does Delta Dental Premier, +1500, 100/80/50, 50, PF Health Insurance Plan, 21989AK0130003 support Mail Ordering?

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

  • Does (21989AK0130003) Health Insurance Plan, Variant (21989AK0130003-00) have Out Of Country Coverage?

    Yes. Details: Treated as out-of-network

    Does (21989AK0130003) Health Insurance Plan, Variant (21989AK0130003-00) have Out of Service Area Coverage?

    Yes. Details: National network

 

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