DentaTrust-PPO Family Low Option - 18239AL0010004 Health Insurance Plan

Dental Care Plus, Inc. health insurance plan with the Plan ID 18239AL0010004. The plan is called DentaTrust-PPO Family Low Option.

Health Insurance Plan ID 18239AL0010004
Health Insurance Plan Year 2025
State Alabama
Health Insurance Issuer Dental Care Plus, Inc.
Health Insurance Plan Variant 18239AL0010004-00
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 Alabama All US States
All 149 154
PCP 1 1
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 96 98
Available Variants of the Health Plan

Standard Off Exchange Plan - 18239AL0010004-00

Standard On Exchange Plan - 18239AL0010004-01

Last Plan Update Date Thu, 15 Aug 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of DentaTrust-PPO Family Low Option Health Insurance Plan, 18239AL0010004-00

Benefit Covered In Network Out Of Network
Accidental Dental
NO
Basic Dental Care - Adult

Subject to a 6 month waiting period. See plan brochure for plan details and limitations and exclusions.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Basic Dental Care - Child

See plan brochure for plan details and limitations and exclusions.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

See plan brochure for plan details and limitations and exclusions.

YES

$10.00, No Charge

$10.00, No Charge
Major Dental Care - Adult

Subject to a 12 month waiting period. See plan brochure for plan details and limitations and exclusions.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Major Dental Care - Child

See plan brochure for plan details and limitations and exclusions.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child

Exclusions: Non-medically necessary orthodontic treatment will not be covered by the plan.

See plan brochure for plan details and limitations and exclusions.

YES

50.00%

50.00%
Routine Dental Services (Adult)

Limit: 1.0 Visit(s) per 6 Months

See plan brochure for plan details and limitations and exclusions.

YES

$10.00, No Charge

$10.00, No Charge

DentaTrust-PPO Family Low Option Health Insurance Plan Variant 18239AL0010004-00 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 Low Off Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1.0
First Tier Utilization 100%
HIOS Product ID 18239AL001
Import Date 2024-08-15 01:01:23
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 18239
Issuer Marketplace Marketing Name DentaTrust
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 Low
Multiple In Network Tiers No
National Network No
Network ID ALN001
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.
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 18239AL0010004-00
Plan Marketing Name DentaTrust-PPO Family Low Option
Plan Type PPO
Plan Variant Marketing Name DentaTrust-PPO Family Low Option
QHP/Non QHP Both
Service Area ID ALS001
Source Name HIOS
Plan ID 18239AL0010004
State Code AL
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of DentaTrust-PPO Family Low Option Health Insurance Plan, 18239AL0010004

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

Frequently Asked Questions(FAQ) about DentaTrust-PPO Family Low Option, 18239AL0010004 Health Insurance Plan, 18239AL0010004

  • Does DentaTrust-PPO Family Low Option Health Insurance Plan, 18239AL0010004 support Mail Ordering?

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

  • Does (18239AL0010004) Health Insurance Plan, Variant (18239AL0010004-00) have Out Of Country Coverage?

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

    Does (18239AL0010004) Health Insurance Plan, Variant (18239AL0010004-00) have Out of Service Area Coverage?

    Yes. 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.

 

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