DentaQuest PPO Family High - 11904LA0010012 Health Insurance Plan

DentaQuest USA Insurance Company, Inc. health insurance plan with the Plan ID 11904LA0010012. The plan is called DentaQuest PPO Family High.

Health Insurance Plan ID 11904LA0010012
Health Insurance Plan Year 2025
State Louisiana
Health Insurance Issuer DentaQuest USA Insurance Company, Inc.
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 11904LA0010012-00
Provider Network(s) NULL
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 Louisiana All US States
All 179 183
PCP 7 7
Allergy 1 1
OB/GYN N/A N/A
Dentists 119 122
Available Variants of the Health Plan

Standard Off Exchange Plan - 11904LA0010012-00

Standard On Exchange Plan - 11904LA0010012-01

Last Plan Update Date Tue, 13 Aug 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of DentaQuest PPO Family High Health Insurance Plan, 11904LA0010012-00

Benefit Covered In Network Out Of Network
Accidental Dental

Limit: 1.0 Treatment(s) per Episode

limit of service varies based upon procedure, see summary of benefits for additional information

YES

No Charge

No Charge
Basic Dental Care - Adult

These services have a 6 month waiting period

YES

20.00% Coinsurance after deductible

20.00% Coinsurance after deductible
Basic Dental Care - Child
YES

20.00% Coinsurance after deductible

20.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 1.0 Exam(s) per 6 Months

YES

No Charge

No Charge
Major Dental Care - Adult

Limit: 1.0 Item(s) per 3 Years

These services have a 12 month waiting period. Limit of service varies based upon procedure, see summary of benefits for additional information

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
YES

50.00%

50.00%
Routine Dental Services (Adult)

Limit: 2.0 Visit(s) per Year

YES

No Charge

No Charge

DentaQuest PPO Family High Health Insurance Plan Variant 11904LA0010012-00 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
EHB Apportionment for Pediatric Dental 1.0
First Tier Utilization 100%
HIOS Product ID 11904LA001
Import Date 2024-08-13 01:01:24
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 11904
Issuer Marketplace Marketing Name DentaQuest- LA
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 $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 $800 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $400 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $400
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 No
Network ID LAN002
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Only. In excess of 50 miles from nearest provider.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 11904LA0010012-00
Plan Marketing Name DentaQuest PPO Family High
Plan Type PPO
Plan Variant Marketing Name DentaQuest PPO Family High
QHP/Non QHP Both
Service Area ID LAS001
Source Name HIOS
Plan ID 11904LA0010012
State Code LA
URL for Enrollment Payment URL

Copay & Coinsurance of DentaQuest PPO Family High Health Insurance Plan, 11904LA0010012

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

Frequently Asked Questions(FAQ) about DentaQuest PPO Family High, 11904LA0010012 Health Insurance Plan, 11904LA0010012

  • Does DentaQuest PPO Family High Health Insurance Plan, 11904LA0010012 support Mail Ordering?

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

  • Does (11904LA0010012) Health Insurance Plan, Variant (11904LA0010012-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (11904LA0010012) Health Insurance Plan, Variant (11904LA0010012-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Only. In excess of 50 miles from nearest provider.

 

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