PPO - Plan #019 - 900 - 99734OH0020023 Health Insurance Plan
Dental Care Plus, Inc. health insurance plan with the Plan ID 99734OH0020023. The plan is called PPO - Plan #019 - 900.
| Health Insurance Plan ID | 99734OH0020023 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Ohio | ||||||||||||||||||
| Health Insurance Issuer | Dental Care Plus, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 99734OH0020023-00 | ||||||||||||||||||
| Provider Network(s) | ['OHN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 14 May 2024 06:16 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Fri, 12 Aug 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 14 May 2024 06:16 GMT |
Benefits of PPO - Plan #019 - 900 Health Insurance Plan, 99734OH0020023-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
Please refer to the Certificate of Coverage for a complete list of covered procedures that fall into the into the Basic category for children and the applicable limitations associated with each. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per 6 Months Routine examinations and prophylaxis treatments are limited to two per year. Please refer to the Certificate of Coverage for a complete list of other covered procedures and limitations that are not listed here that fall into the Preventive category for children. |
YES | No Charge, 20.00% |
No Charge, 20.00% |
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
Please refer to the Certificate of Coverage for a complete list of covered procedures that fall into the Major category for children and the applicable limitations associated with each. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Exclusions: Non-medically necessary Limited to medically necessary orthodontic treatment for children under age 19. |
YES | 50.00% |
50.00% |
| Routine Dental Services (Adult)
|
NO |
PPO - Plan #019 - 900 Health Insurance Plan Variant 99734OH0020023-00 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 | 2023 |
| 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 | 99734OH002 |
| Import Date | 8/12/2022 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 99734 |
| Issuer Marketplace Marketing Name | DentaTrust/DentaSpan |
| 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 | $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 | Yes |
| Network ID | OHN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network. Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists. See the schedule of benefits for in-network and out-of-network coverage levels. |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 99734OH0020023-00 |
| Plan Level Exclusions | Please refer to the exclusions listed in the Certificate for specific plan level exclusions. |
| Plan Marketing Name | PPO - Plan #019 - 900 |
| Plan Type | PPO |
| Plan Variant Marketing Name | PPO - Plan #019 - 900 |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | OHS003 |
| Source Name | SERFF |
| Plan ID | 99734OH0020023 |
| State Code | OH |
Copay & Coinsurance of PPO - Plan #019 - 900 Health Insurance Plan, 99734OH0020023
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about PPO - Plan #019 - 900, 99734OH0020023 Health Insurance Plan, 99734OH0020023
-
Does PPO - Plan #019 - 900 Health Insurance Plan, 99734OH0020023 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (99734OH0020023) Health Insurance Plan, Variant (99734OH0020023-00) have Out Of Country Coverage?
Does (99734OH0020023) Health Insurance Plan, Variant (99734OH0020023-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 14 May 2024 06:16 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