Guardian Pediatric Essentials - 81457OK0020006 Health Insurance Plan

Guardian Life Insurance Company of America health insurance plan with the Plan ID 81457OK0020006. The plan is called Guardian Pediatric Essentials.

Health Insurance Plan ID 81457OK0020006
Health Insurance Plan Year 2025
State Oklahoma
Health Insurance Issuer Guardian Life Insurance Company of America
Health Insurance Plan Variant 81457OK0020006-00
Provider Network(s) ['OKN001']
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 Oklahoma All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 81457OK0020006-00

Last Plan Update Date Sat, 14 Sep 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Guardian Pediatric Essentials Health Insurance Plan, 81457OK0020006-00

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

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

YES

20.00%

20.00% Coinsurance after deductible
Major Dental Care - Adult
NO
Major Dental Care - Child
YES

50.00% Coinsurance after deductible

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

50.00%

70.00%
Routine Dental Services (Adult)
NO

Guardian Pediatric Essentials Health Insurance Plan Variant 81457OK0020006-00 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 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 81457OK002
Import Date 2024-09-14 01:01:31
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan New
Issuer ID 81457
Issuer Marketplace Marketing Name Guardian
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 $150 per person
Medical EHB Deductible, In Network (Tier 1), Individual $150
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person $150 per person
Medical EHB Deductible, Out of Network, Individual $150
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group $850 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $425 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $425
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 OKN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Coverage is provided outside of the Service Area
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 81457OK0020006-00
Plan Marketing Name Guardian Pediatric Essentials
Plan Type PPO
Plan Variant Marketing Name Guardian Pediatric Essentials
QHP/Non QHP Off the Exchange
Service Area ID OKS002
Source Name HIOS
Plan ID 81457OK0020006
State Code OK

Copay & Coinsurance of Guardian Pediatric Essentials Health Insurance Plan, 81457OK0020006

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

Frequently Asked Questions(FAQ) about Guardian Pediatric Essentials, 81457OK0020006 Health Insurance Plan, 81457OK0020006

  • Does Guardian Pediatric Essentials Health Insurance Plan, 81457OK0020006 support Mail Ordering?

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

  • Does (81457OK0020006) Health Insurance Plan, Variant (81457OK0020006-00) have Out Of Country Coverage?

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

    Does (81457OK0020006) Health Insurance Plan, Variant (81457OK0020006-00) have Out of Service Area Coverage?

    Yes. Details: Coverage is provided outside of the Service Area

 

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