DentaTrust-PPO Family High Option · 49941WI0040003
DentaTrust/DentaSpan offers this marketplace health insurance plan (Plan ID 49941WI0040003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.
Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Wisconsin). Submit changes before the deadline to avoid a coverage gap.
Enroll by Dec 15 for Jan 1 starts.
Finalize plan switches before the window closes.
Special Enrollment Periods
You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).
Report the event within 60 days.
Keep documentation handy for Healthcare.gov or your state exchange.
CSR & subsidy reminders
Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.
Enter accurate income to maximize Advanced Premium Tax Credits.
Standard High Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.
Thinking about switching?
Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.
Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.
Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.
Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).
Tier 1 in-network20.00% Coinsurance after deductible
Out-of-network20.00% Coinsurance after deductible
Subject to a 6 month waiting period. See plan brochure for plan details and limitations and exclusions.
Exclusions: nan
Dental Check-Up for Children
No Charge
Tier 1 in-networkNo Charge
Out-of-networkNo Charge
Limit: 2.0 Visit(s) per Year
See plan brochure for plan details and limitations and exclusions.
Exclusions: nan
Major Dental Care - Adult
50.00% Coinsurance after deductible
Tier 1 in-network50.00% Coinsurance after deductible
Out-of-network50.00% Coinsurance after deductible
Subject to a 12 month waiting period. See plan brochure for plan details and limitations and exclusions.
Exclusions: nan
Orthodontia - Adult
Coverage details pending
nan
Exclusions: nan
Orthodontia - Child
50.00%
Tier 1 in-network50.00%
Out-of-network50.00%
See plan brochure for plan details and limitations and exclusions.
Exclusions: Non-medically necessary orthodontic treatment will not be covered by the plan.
Routine Dental Services (Adult)
No Charge
Tier 1 in-networkNo Charge
Out-of-networkNo Charge
Limit: 2.0 Visit(s) per Year
See plan brochure for plan details and limitations and exclusions.
Exclusions: nan
Variant attributes
DentaTrust-PPO Family High Option · Variant 49941WI0040003-00
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2025
CSR Variation Type
Standard High Off Exchange Plan
HIOS Product ID
49941WI004
Metal Level
High
Plan ID (Standard Component ID with Variant)
49941WI0040003-00
Plan Marketing Name
DentaTrust-PPO Family High Option
Plan Variant Marketing Name
DentaTrust-PPO Family High Option
Issuer & service area
Issuer-provided metadata for this variant.
Issuer ID
49941
Issuer Marketplace Marketing Name
DentaTrust/DentaSpan
Market Coverage
Individual
Multiple In Network Tiers
No
National Network
No
Network ID
WIN001
Out of Country Coverage
No
Out of Service Area Coverage
Yes
Out of Service Area Coverage Description
Out-of-Network coverage is available for covered services obtained from non-participating dentists. See the schedule of benefits for out-of-network coverage levels.
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
EHB Apportionment for Pediatric Dental
1.0
First Tier Utilization
100%
Import Date
2024-07-30 01:01:40
Guaranteed Rate
Guaranteed Rate
New/Existing Plan
Existing
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
Plan Effective Date
2025-01-01
Plan Expiration Date
2025-12-31
Plan Type
PPO
QHP/Non QHP
Both
Source Name
HIOS
Plan ID
49941WI0040003
Copay & coinsurance
Pharmacy cost sharing by tier
Drug tier
Pharmacy type
Copay amount
Copay option
Coinsurance rate
Coinsurance option
Mail order
Questions & answers
Frequently asked questions
How do I choose the right ACA plan in Wisconsin?
DentaTrust-PPO Family High Option (49941WI0040003) is a High PPO from DentaTrust/DentaSpan in Wisconsin for the 2025 coverage year.
Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.
Does DentaTrust-PPO Family High Option support telehealth or virtual urgent care?
The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.
Is DentaTrust-PPO Family High Option HSA-eligible and does it include dental or vision coverage?
HSA eligibility is not published; check the Summary of Benefits or ask the issuer.
Dental add-ons: Adult, Child.
Vision coverage is not listed for this plan.
Does DentaTrust-PPO Family High Option support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Is there out-of-country coverage for DentaTrust-PPO Family High Option?
No, out-of-country services are not covered for this plan.
Does DentaTrust-PPO Family High Option cover care outside the service area?
Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Out-of-Network coverage is available for covered services obtained from non-participating dentists. See the schedule of benefits for out-of-network coverage levels.
How do I enroll in or manage payments for DentaTrust-PPO Family High Option?
Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
