DentaQuest PPO Family Low - 58883MO0010004 Health Insurance Plan

DentaQuest National Insurance Company, Inc. health insurance plan with the Plan ID 58883MO0010004. The plan is called DentaQuest PPO Family Low.

Health Insurance Plan ID 58883MO0010004
Health Insurance Plan Year 2022
State Missouri
Health Insurance Issuer DentaQuest National Insurance Company, Inc.
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 58883MO0010004-00
Provider Network(s) ['MON001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Jul 2024 06:37 GMT).

Providers Missouri 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 - 58883MO0010004-00

Standard On Exchange Plan - 58883MO0010004-01

Last Plan Update Date Tue, 18 May 2021 00:00 GMT
Last Import Date Tue, 23 Jul 2024 06:37 GMT

DentaQuest PPO Family Low Health Insurance Plan Variant 58883MO0010004-00 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 2022
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
First Tier Utilization 100%
HIOS Product ID 58883MO001
Import Date 5/18/2021 1:00
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 58883
Issuer Marketplace Marketing Name DentaQuest Insurance Company-MO
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 $150 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person $50 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $50
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 $700 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $350 per person
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 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 MON001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Only. In excess of 50 miles from nearest provider.
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 58883MO0010004-00
Plan Marketing Name DentaQuest PPO Family Low
Plan Type PPO
Plan Variant Marketing Name DentaQuest PPO Family Low
QHP/Non QHP Both
Service Area ID MOS001
Source Name HIOS
Plan ID 58883MO0010004
State Code MO
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of DentaQuest PPO Family Low Health Insurance Plan, 58883MO0010004

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

Frequently Asked Questions(FAQ) about DentaQuest PPO Family Low, 58883MO0010004 Health Insurance Plan, 58883MO0010004

  • Does DentaQuest PPO Family Low Health Insurance Plan, 58883MO0010004 support Mail Ordering?

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

  • Does (58883MO0010004) Health Insurance Plan, Variant (58883MO0010004-00) have Out Of Country Coverage?

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

    Does (58883MO0010004) Health Insurance Plan, Variant (58883MO0010004-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Only. In excess of 50 miles from nearest provider.

 

Disclaimer: This is based on the import(Date: Tue, 23 Jul 2024 06:37 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