EHB Low PPO - 38791MI0040001 Health Insurance Plan
Ameritas Life Insurance Corp. health insurance plan with the Plan ID 38791MI0040001. The plan is called EHB Low PPO.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 69.20% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.80% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 38791MI0040001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Michigan | ||||||||||||||||||
| Health Insurance Issuer | Ameritas Life Insurance Corp. | ||||||||||||||||||
| Health Insurance Plan Variant | 38791MI0040001-00 | ||||||||||||||||||
| Provider Network(s) | ['MIN001'] | ||||||||||||||||||
| 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, 08 Aug 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Benefits of EHB Low PPO Health Insurance Plan, 38791MI0040001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
YES | 45% Coinsurance after deductible |
60% Coinsurance after deductible |
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
MIChild, Pages 8-9 |
YES | 45% Coinsurance after deductible |
60% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year MIChild, Pages 8-9 |
YES | No Charge after deductible |
40% Coinsurance after deductible |
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
MIChild, Pages 8-9 |
YES | 65% Coinsurance after deductible |
80% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
NO | ||
| Routine Dental Services (Adult)
|
NO |
EHB Low PPO Health Insurance Plan Variant 38791MI0040001-00 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 | 2023 |
| Child-Only Offering | Allows Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low Off Exchange Plan |
| Dental Only Plan | Yes |
| First Tier Utilization | 100% |
| HIOS Product ID | 38791MI004 |
| Import Date | 8/8/2022 20:00 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Estimated Rate |
| New/Existing Plan | Existing |
| Issuer Actuarial Value | 69.20% |
| Issuer ID | 38791 |
| Issuer Marketplace Marketing Name | Ameritas Life Insurance Corp. |
| Market Coverage | SHOP (Small Group) |
| 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 | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| 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 | $750 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $375 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $375 |
| 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 | Yes |
| Network ID | MIN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.†|
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 38791MI0040001-00 |
| Plan Marketing Name | EHB Low PPO |
| Plan Type | PPO |
| Plan Variant Marketing Name | EHB Low PPO |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | MIS001 |
| Source Name | SERFF |
| Plan ID | 38791MI0040001 |
| State Code | MI |
Copay & Coinsurance of EHB Low PPO Health Insurance Plan, 38791MI0040001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about EHB Low PPO, 38791MI0040001 Health Insurance Plan, 38791MI0040001
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Does EHB Low PPO Health Insurance Plan, 38791MI0040001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (38791MI0040001) Health Insurance Plan, Variant (38791MI0040001-00) have Out Of Country Coverage?
Yes. Details: We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.
Does (38791MI0040001) Health Insurance Plan, Variant (38791MI0040001-00) have Out of Service Area Coverage?
Yes. Details: Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.â€
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