Delta Dental Select Plan - Family or Child Only - 30045AZ0010032 Health Insurance Plan
Arizona Dental Insurance Service, Inc. health insurance plan with the Plan ID 30045AZ0010032. The plan is called Delta Dental Select Plan - Family or Child Only.
| Health Insurance Plan ID | 30045AZ0010032 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Arizona | ||||||||||||||||||
| Health Insurance Issuer | Arizona Dental Insurance Service, Inc. | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 30045AZ0010032-00 | ||||||||||||||||||
| Provider Network(s) | ['AZN002'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Fri, 12 Aug 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 30 Apr 2024 06:06 GMT |
Benefits of Delta Dental Select Plan - Family or Child Only Health Insurance Plan, 30045AZ0010032-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
Exclusions: For a full list of exclusions, please see the summary of benefits. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Basic Dental Care - Adult
Exclusions: For a full list of exclusions, please see the summary of benefits. |
YES | 20.00% Coinsurance after deductible |
30.00% Coinsurance after deductible |
| Basic Dental Care - Child
Exclusions: For a full list of exclusions, please see the summary of benefits. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Dental Check-Up for Children
Exclusions: For a full list of exclusions, please see the summary of benefits. 1 dental check-up per 6 months |
YES | 0.00% |
0.00% |
| Major Dental Care - Adult
Exclusions: For a full list of exclusions, please see the summary of benefits. |
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Major Dental Care - Child
Exclusions: For a full list of exclusions, please see the summary of benefits. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Exclusions: For a full list of exclusions, please see the summary of benefits. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
Limit: 1.0 Visit(s) per 6 Months Exclusions: For a full list of exclusions, please see the summary of benefits. 1 dental check-up per 6 months |
YES | 0.00% |
10.00% |
Delta Dental Select Plan - Family or Child Only Health Insurance Plan Variant 30045AZ0010032-00 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 High Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1 |
| First Tier Utilization | 100% |
| HIOS Product ID | 30045AZ001 |
| Import Date | 8/12/2022 1:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 30045 |
| Issuer Marketplace Marketing Name | Delta Dental of Arizona |
| Market Coverage | Individual |
| 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 | $25 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $25 |
| 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 | $750 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $375 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $375 |
| 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 | AZN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | In a foreign country and need emergency dental treatment? You are covered with Delta Dental wherever you go. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Traveling out of state and need dental treatment? Delta Dental is there to cover you with America's largest network of dentists. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 30045AZ0010032-00 |
| Plan Level Exclusions | For a full list of exclusions, please see the summary of benefits. |
| Plan Marketing Name | Delta Dental Select Plan - Family or Child Only |
| Plan Type | PPO |
| Plan Variant Marketing Name | Delta Dental Select Plan - Family or Child Only |
| QHP/Non QHP | Both |
| Service Area ID | AZS001 |
| Source Name | HIOS |
| Plan ID | 30045AZ0010032 |
| State Code | AZ |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Delta Dental Select Plan - Family or Child Only Health Insurance Plan, 30045AZ0010032
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Delta Dental Select Plan - Family or Child Only, 30045AZ0010032 Health Insurance Plan, 30045AZ0010032
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Does Delta Dental Select Plan - Family or Child Only Health Insurance Plan, 30045AZ0010032 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (30045AZ0010032) Health Insurance Plan, Variant (30045AZ0010032-00) have Out Of Country Coverage?
Does (30045AZ0010032) Health Insurance Plan, Variant (30045AZ0010032-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 30 Apr 2024 06:06 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