HMSA Individual Dental PPO Bronze - 18350HI0920004 Health Insurance Plan
Hawaii Medical Service Association health insurance plan with the Plan ID 18350HI0920004. The plan is called HMSA Individual Dental PPO Bronze.
| Health Insurance Plan ID | 18350HI0920004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Hawaii | ||||||||||||||||||
| Health Insurance Issuer | Hawaii Medical Service Association | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 18350HI0920004-00 | ||||||||||||||||||
| Provider Network(s) | ['HIN004'] | ||||||||||||||||||
| 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 | Wed, 29 Nov 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Benefits of HMSA Individual Dental PPO Bronze Health Insurance Plan, 18350HI0920004-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
Exclusions: Not Covered |
NO | ||
| Basic Dental Care - Adult
Fillings -6 month waiting period. See policy for details |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Basic Dental Care - Child
Fillings -See policy for details |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Dental Check-Up for Children
Cleaning, fluoride, exams, sealants - See policy for details |
YES | 10.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Major Dental Care - Adult
Exclusions: Not Covered |
NO | ||
| Major Dental Care - Child
Crowns -See policy for details |
YES | 60.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Orthodontia - Adult
Exclusions: Not Covered |
NO | ||
| Orthodontia - Child
Medically Necessary Only |
YES | 50.00% |
100.00% |
| Routine Dental Services (Adult)
Cleaning, exams - See policy for details |
YES | 10.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
HMSA Individual Dental PPO Bronze Health Insurance Plan Variant 18350HI0920004-00 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 | 2024 |
| 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 | 0.993 |
| First Tier Utilization | 100% |
| HIOS Product ID | 18350HI092 |
| Import Date | 2023-11-29 20:03:17 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 18350 |
| Issuer Marketplace Marketing Name | HMSA |
| 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 | $25 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $25 |
| 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 | $800 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $400 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $400 |
| 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 | No |
| Network ID | HIN004 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of area service benefits are available as defined in the Policy but members may have a higher cost share |
| Plan Brochure | URL |
| Plan Effective Date | 2024-01-01 |
| Plan Expiration Date | 2024-12-31 |
| Plan ID (Standard Component ID with Variant) | 18350HI0920004-00 |
| Plan Marketing Name | HMSA Individual Dental PPO Bronze |
| Plan Type | PPO |
| Plan Variant Marketing Name | HMSA Individual Dental PPO Bronze |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | HIS002 |
| Source Name | SERFF |
| Plan ID | 18350HI0920004 |
| State Code | HI |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
Copay & Coinsurance of HMSA Individual Dental PPO Bronze Health Insurance Plan, 18350HI0920004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about HMSA Individual Dental PPO Bronze, 18350HI0920004 Health Insurance Plan, 18350HI0920004
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Does HMSA Individual Dental PPO Bronze Health Insurance Plan, 18350HI0920004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (18350HI0920004) Health Insurance Plan, Variant (18350HI0920004-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (18350HI0920004) Health Insurance Plan, Variant (18350HI0920004-00) have Out of Service Area Coverage?
Yes. Details: Out of area service benefits are available as defined in the Policy but members may have a higher cost share
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