Retailers Insurance Company health insurance plan with the Plan ID 47638MI0010001. The plan is called Retailers Insurance Company - EHB.
Health Insurance Plan ID | 47638MI0010001 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Michigan | ||||||||||||||||||
Health Insurance Issuer | Retailers Insurance Company | ||||||||||||||||||
Health Insurance Plan Variant | 47638MI0010001-00 | ||||||||||||||||||
Provider Network(s) | ['MIN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 01 Oct 2024 06:11 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Sun, 14 Aug 2022 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 01 Oct 2024 06:11 GMT |
Benefit | Covered | In Network | Out Of Network |
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Accidental Dental
|
YES | Tier 1: 0.00% Tier 2: 0.00% |
0.00% |
Basic Dental Care - Adult
|
YES | Tier 1: 50% Coinsurance after deductible Tier 2: 50% Coinsurance after deductible |
50% Coinsurance after deductible |
Basic Dental Care - Child
|
YES | Tier 1: 20% Coinsurance after deductible Tier 2: 40% Coinsurance after deductible |
40% Coinsurance after deductible |
Dental Check-Up for Children
Limit: 2.0 Visit(s) per Benefit Period |
YES | Tier 1: 0.00% Tier 2: 0.00% |
0.00% |
Major Dental Care - Adult
|
YES | Tier 1: 50% Coinsurance after deductible Tier 2: 50% Coinsurance after deductible |
50% Coinsurance after deductible |
Major Dental Care - Child
|
YES | Tier 1: 50% Coinsurance after deductible Tier 2: 50% Coinsurance after deductible |
50% Coinsurance after deductible |
Orthodontia - Adult
|
YES | Tier 1: 50.00% Tier 2: 50.00% |
50.00% |
Orthodontia - Child
|
NO | ||
Routine Dental Services (Adult)
Limit: 2.0 Visit(s) per Benefit Period |
YES | Tier 1: 0.00% Tier 2: 0.00% |
0.00% |
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 Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard High Off Exchange Plan |
Dental Only Plan | Yes |
First Tier Utilization | 25% |
HIOS Product ID | 47638MI001 |
Import Date | 8/14/2022 20:00 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Estimated Rate |
New/Existing Plan | Existing |
Issuer ID | 47638 |
Issuer Marketplace Marketing Name | Retailers Insurance Company |
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 | $0 per group |
Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $0 |
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, In Network (Tier 2), Family Per Group | per group not applicable |
Medical EHB Deductible, In Network (Tier 2), Family Per Person | per person not applicable |
Medical EHB Deductible, In Network (Tier 2), 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 | $750 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $375 per person |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $375 |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Group | $750 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Family Per Person | $375 per person |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 2), Individual | $375 |
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 | High |
Multiple In Network Tiers | Yes |
National Network | Yes |
Network ID | MIN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Emergency Services Only |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Same Benefit Level |
Plan Effective Date | 1/1/2023 |
Plan ID (Standard Component ID with Variant) | 47638MI0010001-00 |
Plan Marketing Name | Retailers Insurance Company - EHB |
Plan Type | PPO |
Plan Variant Marketing Name | Retailers Insurance Company - EHB |
QHP/Non QHP | Off the Exchange |
Second Tier Utilization | 75% |
Service Area ID | MIS001 |
Source Name | SERFF |
Plan ID | 47638MI0010001 |
State Code | MI |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Disclaimer: This is based on the import(Date: Tue, 01 Oct 2024 06:11 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