Dental Choice - 61589ID1720001 Health Insurance Plan
Blue Cross of Idaho Health Service, Inc. health insurance plan with the Plan ID 61589ID1720001. The plan is called Dental Choice.
| Health Insurance Plan ID | 61589ID1720001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Idaho | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross of Idaho Health Service, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 61589ID1720001-01 | ||||||||||||||||||
| Provider Network(s) | ['IDN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Dental Choice Health Insurance Plan Variant 61589ID1720001-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 100% |
| First Tier Utilization | 100% |
| HIOS Product ID | 61589ID172 |
| Import Date | 1/23/2023 |
| Guaranteed Rate | Guaranteed Rate |
| IsItANewPlan | Existing |
| Issuer ID | 61589 |
| Market Coverage | Individual |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family | per person not applicable | per group 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 person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Family | $25 per person | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Individual | $25 |
| Medical EHB Deductible, Out of Network, Family | $100 per person | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | $100 |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family | $350 per person | $700 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $350 |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family | $10000 per person | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual | $10,000 |
| Metal Level | Low |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | IDN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services. Except as provided by the federal No Surprises Act. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 61589ID1720001-01 |
| Plan Marketing Name | Dental Choice |
| Plan Type | PPO |
| Plan Variant Marketing Name | Dental Choice |
| QHP/Non QHP | Both |
| Service Area ID | IDS002 |
| Source Name | SERFF |
| Plan ID | 61589ID1720001 |
| State Code | ID |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Dental Choice Health Insurance Plan, 61589ID1720001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Dental Choice, 61589ID1720001 Health Insurance Plan, 61589ID1720001
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Does Dental Choice Health Insurance Plan, 61589ID1720001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (61589ID1720001) Health Insurance Plan, Variant (61589ID1720001-01) have Out Of Country Coverage?
Yes. Details: The benefits available under this contract are also available to members traveling or living outside the United States. The inpatient notification and prior authorization requirements will apply.
Does (61589ID1720001) Health Insurance Plan, Variant (61589ID1720001-01) have Out of Service Area Coverage?
Yes. Details: In these situations, the enrollee may be responsible for the difference between the amount that the non-participating healthcare provider bills and the payment BCI will make for the covered services. Except as provided by the federal No Surprises Act.
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 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