85427 health insurance plan with the Plan ID 85427NY0010002. The plan is called EssentialSmile 111 NS INN Family Dental Dep 29.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.00% of the costs of all covered benefits (according to the Issuer).
Health Insurance Plan ID | 85427NY0010002 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | New York | ||||||||||||||||||
Health Insurance Issuer | 85427 | ||||||||||||||||||
Health Insurance Plan Variant | 85427NY0010002-01 | ||||||||||||||||||
Provider Network(s) | ['NYN001'] | ||||||||||||||||||
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, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 07 May 2024 06:08 GMT |
Plan Attribute | Value |
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Business Year | 2023 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
Dental Only Plan | Yes |
EHB Apportionment for Pediatric Dental | 100% |
First Tier Utilization | 100% |
HIOS Product ID | 85427NY001 |
Import Date | 1/23/2023 |
Guaranteed Rate | Guaranteed Rate |
IsItANewPlan | Existing |
Issuer Actuarial Value | 70.00% |
Issuer ID | 85427 |
Market Coverage | Individual |
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 | $50 per person | per group not applicable |
Medical EHB Deductible, In Network (Tier 1), Individual | $50 |
Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
Medical EHB Deductible, Out of Network, Individual | Not Applicable |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family | $350 per person | $700 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $350 |
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 | Low |
Multiple In Network Tiers | No |
National Network | No |
Network ID | NYN001 |
Out of Country Coverage | No |
Out of Service Area Coverage | No |
Plan Effective Date | 1/1/2023 |
Plan Expiration Date | 12/31/2023 |
Plan ID (Standard Component ID with Variant) | 85427NY0010002-01 |
Plan Marketing Name | EssentialSmile 111 NS INN Family Dental Dep 29 |
Plan Type | EPO |
Plan Variant Marketing Name | EssentialSmile 111 NS INN Family Dental Dep 29 |
QHP/Non QHP | Both |
Service Area ID | NYS001 |
Source Name | SERFF |
Plan ID | 85427NY0010002 |
State Code | NY |
Version Number | 1 |
Wellness Program Offered | No |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
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