Dental PPO Core - 10091OR0730003 Health Insurance Plan
PacificSource Health Plans health insurance plan with the Plan ID 10091OR0730003. The plan is called Dental PPO Core.
| Health Insurance Plan ID | 10091OR0730003 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | PacificSource Health Plans | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 10091OR0730003-01 | ||||||||||||||||||
| Provider Network(s) | TIER-ONE | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Fri, 14 Nov 2025 22:16 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Fri, 14 Nov 2025 00:00 GMT | ||||||||||||||||||
| Last Import Date | Fri, 14 Nov 2025 22:16 GMT |
Dental PPO Core Health Insurance Plan Variant 10091OR0730003-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | Yes |
| CSR Variation Type | Standard High On Exchange Plan |
| Dental Only Plan | Yes |
| First Tier Utilization | 100% |
| HIOS Product ID | 10091OR073 |
| Import Date | 1/13/2025 |
| Guaranteed Rate | Guaranteed Rate |
| IsItANewPlan | Existing |
| Issuer ID | 10091 |
| Market Coverage | SHOP (Small Group) |
| 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 | per person not applicable | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
| Medical EHB Deductible, Out of Network, Family | $50 per person | $150 per group |
| Medical EHB Deductible, Out of Network, Individual | $50 |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family | $425 per person | $850 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $425 |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family | per person not applicable | per group 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 | ORN003 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency care only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Non-participating providers |
| Plan Effective Date | 1/1/2025 |
| Plan Expiration Date | 12/31/2025 |
| Plan ID (Standard Component ID with Variant) | 10091OR0730003-01 |
| Plan Marketing Name | Dental PPO Core |
| Plan Type | PPO |
| Plan Variant Marketing Name | Dental PPO Core |
| QHP/Non QHP | Both |
| Service Area ID | ORS005 |
| Source Name | SERFF |
| Plan ID | 10091OR0730003 |
| State Code | OR |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Dental PPO Core Health Insurance Plan, 10091OR0730003
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Dental PPO Core, 10091OR0730003 Health Insurance Plan, 10091OR0730003
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Does Dental PPO Core Health Insurance Plan, 10091OR0730003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (10091OR0730003) Health Insurance Plan, Variant (10091OR0730003-01) have Out Of Country Coverage?
Does (10091OR0730003) Health Insurance Plan, Variant (10091OR0730003-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Fri, 14 Nov 2025 22:16 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