Delta Dental Premier Plan - 21989AK0030001 Health Insurance Plan
Oregon Dental Service health insurance plan with the Plan ID 21989AK0030001. The plan is called Delta Dental Premier Plan.
| Health Insurance Plan ID | 21989AK0030001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Alaska | ||||||||||||||||||
| Health Insurance Issuer | Oregon Dental Service | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 21989AK0030001-00 | ||||||||||||||||||
| 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 Plan Health Insurance Plan, 21989AK0030001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Limit: 1100.0 Dollars per Year 6-month exclusion period applies for ages 19 and older. Exclusion periods may be waived with one year of prior dental coverage, and no more than a 90-day break in coverage from the end of the old policy to the effective date of the 2023 Delta Dental policy. |
YES | 35.00% |
35.00% |
| Basic Dental Care - Child
|
YES | 70.00% |
70.00% |
| Dental Check-Up for Children
See policy for additional limitations |
YES | 30.00% |
30.00% |
| Major Dental Care - Adult
Limit: 1100.0 Dollars per Year 12-month exclusion period applies for ages 19 and older. Exclusion periods may be waived with one year of prior dental coverage, and no more than a 90-day break in coverage from the end of the old policy to the effective date of the 2023 Delta Dental policy. |
YES | 50.00% |
50.00% |
| Major Dental Care - Child
|
YES | 70.00% |
70.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Only medically necessary orthodontia is covered |
YES | 70.00% |
70.00% |
| Routine Dental Services (Adult)
Limit: 1100.0 Dollars per Year $1,100 annual maximum plan payment limit combined for all routine, basic, and major services. |
YES | 20.00% |
20.00% |
Delta Dental Premier Plan Health Insurance Plan Variant 21989AK0030001-00 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 |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1 |
| First Tier Utilization | 100% |
| HIOS Product ID | 21989AK003 |
| Import Date | 11/19/2022 1:01 |
| 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 | Individual |
| 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 | $0 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $0 |
| 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 | Low |
| 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) | 21989AK0030001-00 |
| Plan Marketing Name | Delta Dental Premier Plan |
| Plan Type | Indemnity |
| Plan Variant Marketing Name | Delta Dental Premier Plan |
| QHP/Non QHP | Both |
| Service Area ID | AKS001 |
| Source Name | HIOS |
| Plan ID | 21989AK0030001 |
| State Code | AK |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Delta Dental Premier Plan Health Insurance Plan, 21989AK0030001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Delta Dental Premier Plan, 21989AK0030001 Health Insurance Plan, 21989AK0030001
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Does Delta Dental Premier Plan Health Insurance Plan, 21989AK0030001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (21989AK0030001) Health Insurance Plan, Variant (21989AK0030001-00) have Out Of Country Coverage?
Does (21989AK0030001) Health Insurance Plan, Variant (21989AK0030001-00) have Out of Service Area Coverage?
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