SDC-Kids Plan Low - 30042OH0020001 Health Insurance Plan
Superior Dental Care, Inc. health insurance plan with the Plan ID 30042OH0020001. The plan is called SDC-Kids Plan Low.
| Health Insurance Plan ID | 30042OH0020001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Ohio | ||||||||||||||||||
| Health Insurance Issuer | Superior Dental Care, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 30042OH0020001-00 | ||||||||||||||||||
| Provider Network(s) | ['OHN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 04 Nov 2025 05:30 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 26 Jun 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 04 Nov 2025 05:30 GMT |
Benefits of SDC-Kids Plan Low Health Insurance Plan, 30042OH0020001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 30.00% Coinsurance after deductible |
No Charge, 50.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 1.0 Exam(s) per 6 Months Exclusions: nan Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 10.00% Coinsurance after deductible |
No Charge, 30.00% Coinsurance after deductible |
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 50.00% Coinsurance after deductible |
No Charge, 70.00% Coinsurance after deductible |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 50.00% |
No Charge, 50.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO |
SDC-Kids Plan Low Health Insurance Plan Variant 30042OH0020001-00 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 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 | 30042OH002 |
| Import Date | 2024-06-26 20:01:28 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 30042 |
| Issuer Marketplace Marketing Name | Superior Dental Care, Inc. |
| Market Coverage | SHOP (Small Group) |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | $750 per group |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | $375 per person |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $375 |
| 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 | $225 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $225 |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $75 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $75 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | $150 per person |
| Medical EHB Deductible, Out of Network, Individual | $150 |
| 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, 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 | Yes |
| Out of Country Coverage Description | Matches in County Coverage |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Matches in County Coverage |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 30042OH0020001-00 |
| Plan Marketing Name | SDC-Kids Plan Low |
| Plan Type | PPO |
| Plan Variant Marketing Name | SDC-Kids Plan Low |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | OHS001 |
| Source Name | SERFF |
| Plan ID | 30042OH0020001 |
| State Code | OH |
Copay & Coinsurance of SDC-Kids Plan Low Health Insurance Plan, 30042OH0020001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about SDC-Kids Plan Low, 30042OH0020001 Health Insurance Plan, 30042OH0020001
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Does SDC-Kids Plan Low Health Insurance Plan, 30042OH0020001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (30042OH0020001) Health Insurance Plan, Variant (30042OH0020001-00) have Out Of Country Coverage?
Does (30042OH0020001) Health Insurance Plan, Variant (30042OH0020001-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 04 Nov 2025 05:30 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