Family Dental PPO - 27603CA1330004 Health Insurance Plan
Anthem Blue Cross (DMHC) health insurance plan with the Plan ID 27603CA1330004. The plan is called Family Dental PPO.
| Health Insurance Plan ID | 27603CA1330004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | California | ||||||||||||||||||
| Health Insurance Issuer | Anthem Blue Cross (DMHC) | ||||||||||||||||||
| Health Insurance Plan Variant | 27603CA1330004-01 | ||||||||||||||||||
| Provider Network(s) | ['CAN004'] | ||||||||||||||||||
| 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, 17 Apr 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Family Dental PPO Health Insurance Plan Variant 27603CA1330004-01 Attributes
| Plan Attribute | Value |
|---|---|
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard High On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 100% |
| First Tier Utilization | 100% |
| HIOS Product ID | 27603CA133 |
| Import Date | 4/17/2023 |
| Guaranteed Rate | Guaranteed Rate |
| IsItANewPlan | Existing |
| Issuer ID | 27603 |
| 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 | $75 per person | $150 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $75 |
| Medical EHB Deductible, Out of Network, Family | $75 per person | $150 per group |
| Medical EHB Deductible, Out of Network, Individual | $75 |
| 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 | High |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | CAN004 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Out of Country covered services are reimbursed as out-of-network benefits. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | If a member does not use a network dentist, services will be reimbursed at the out-of-network level. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 27603CA1330004-01 |
| Plan Marketing Name | Family Dental PPO |
| Plan Type | PPO |
| Plan Variant Marketing Name | Family Dental PPO |
| QHP/Non QHP | On the Exchange |
| Service Area ID | CAS022 |
| Source Name | SERFF |
| Plan ID | 27603CA1330004 |
| State Code | CA |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of Family Dental PPO Health Insurance Plan, 27603CA1330004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Family Dental PPO, 27603CA1330004 Health Insurance Plan, 27603CA1330004
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Does Family Dental PPO Health Insurance Plan, 27603CA1330004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (27603CA1330004) Health Insurance Plan, Variant (27603CA1330004-01) have Out Of Country Coverage?
Yes. Details: Out of Country covered services are reimbursed as out-of-network benefits.
Does (27603CA1330004) Health Insurance Plan, Variant (27603CA1330004-01) have Out of Service Area Coverage?
Yes. Details: If a member does not use a network dentist, services will be reimbursed at the out-of-network level.
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