Guardian Select for Families and Individuals - 55440NC0220006 Health Insurance Plan

The Guardian Life Insurance Company health insurance plan with the Plan ID 55440NC0220006. The plan is called Guardian Select for Families and Individuals.

Health Insurance Plan ID 55440NC0220006
Health Insurance Plan Year 2025
State North Carolina
Health Insurance Issuer The Guardian Life Insurance Company
Health Insurance Plan Variant 55440NC0220006-00
Provider Network(s) CS--STRATOSE-QUALIDENT-DENTAL-NETWORK CS--STRATOSE-TDA-PPO CR--PREMIER-MN-FL-DENTAL-NETWORK-EXCEL CD--DENTALGUARD-CONNECT---ADMIN-PROVIDERS CS--STRATOSE-MDENT CD--PREMIER-ACCESS-PCN CJ--CAREINGTON-PLATINUM CM--METLIFE CS--STRATOSE-FSB-MAVEREST DD--DENTALGUARD-ELITE CS--AETNA CJ--CAREINGTON-CARESERIES CR--PREMIER-MN-FL-DENTAL-NETWORK-CLASSIC CX--CONNECTION-DENTAL--PPO-USA CA--PREMIER-ACCESS-PPO CS--STRATOSE-PCDPRI CW--DENTEMAX CS--STRATOSE-PDPPRI
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 North Carolina All US States
All 2538 3149
PCP 1 2
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 1773 2136
Available Variants of the Health Plan

Standard Off Exchange Plan - 55440NC0220006-00

Standard On Exchange Plan - 55440NC0220006-01

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

Benefits of Guardian Select for Families and Individuals Health Insurance Plan, 55440NC0220006-00

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

An annual deductible and maximum apply to adult services. A 6-month waiting period applies to Basic Dental Care for adults.

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Basic Dental Care - Child
YES

50.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Benefit Period

YES

No Charge after deductible

10.00% Coinsurance after deductible
Major Dental Care - Adult

An annual deductible and maximum apply to adult services. A 12-month waiting period applies to Major Dental Care for adults.

YES

50.00% Coinsurance after deductible

70.00% Coinsurance after deductible
Major Dental Care - Child
YES

50.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child
YES

50.00%

70.00%
Routine Dental Services (Adult)

An annual deductible and maximum apply to adult services.

YES

No Charge after deductible

30.00% Coinsurance after deductible

Guardian Select for Families and Individuals Health Insurance Plan Variant 55440NC0220006-00 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 55440NC022
Import Date 2024-09-14 01:01:31
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan New
Issuer ID 55440
Issuer Marketplace Marketing Name Guardian
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 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 $50 per person
Medical EHB Deductible, In Network (Tier 1), Individual $50
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person $100 per person
Medical EHB Deductible, Out of Network, Individual $100
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 NCN001
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) 55440NC0220006-00
Plan Marketing Name Guardian Select for Families and Individuals
Plan Type PPO
Plan Variant Marketing Name Guardian Select for Families and Individuals
QHP/Non QHP Both
Service Area ID NCS001
Source Name HIOS
Plan ID 55440NC0220006
State Code NC
URL for Enrollment Payment URL

Copay & Coinsurance of Guardian Select for Families and Individuals Health Insurance Plan, 55440NC0220006

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

Frequently Asked Questions(FAQ) about Guardian Select for Families and Individuals, 55440NC0220006 Health Insurance Plan, 55440NC0220006

  • Does Guardian Select for Families and Individuals Health Insurance Plan, 55440NC0220006 support Mail Ordering?

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

  • Does (55440NC0220006) Health Insurance Plan, Variant (55440NC0220006-00) have Out Of Country Coverage?

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

    Does (55440NC0220006) Health Insurance Plan, Variant (55440NC0220006-00) 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