Super SmartSmile - EC - 25486OR0020002 Health Insurance Plan

Dental Health Services, Inc. health insurance plan with the Plan ID 25486OR0020002. The plan is called Super SmartSmile - EC.

Health Insurance Plan ID

25486OR0020002

Health Insurance Plan Year

2023

State

Oregon

Health Insurance Issuer

Dental Health Services, Inc.

Plan Marketing Materials URL

Marketing URL

Health Insurance Plan Variant

25486OR0020002-00

Provider Network(s)

['ORN001']

In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 30 Apr 2024 06:06 GMT).

Providers	Oregon	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 - 25486OR0020002-00

Standard On Exchange Plan - 25486OR0020002-01

Last Plan Update Date

Tue, 16 Aug 2022 00:00 GMT

Last Import Date

Tue, 30 Apr 2024 06:06 GMT

Benefits of Super SmartSmile - EC Health Insurance Plan, 25486OR0020002-00

Benefit	Covered	In Network	Out Of Network
Accidental Dental	NO
Basic Dental Care - Adult Exclusions: See Policy for detailed exclusions	YES	$25.00, No Charge	100.00%
Basic Dental Care - Child Exclusions: See Policy for detailed exclusions Supplemented with OHP Plus.	YES	$47.00, No Charge	100.00%
Dental Check-Up for Children Limit: 1.0 Procedure(s) per 6 Months Exclusions: See Policy for detailed exclusions Supplemented with OHP Plus.	YES	$20.00, No Charge	100.00%
Major Dental Care - Adult Exclusions: See Policy for detailed exclusions	YES	$675.00, No Charge	100.00%
Major Dental Care - Child Exclusions: See Policy for detailed exclusions Supplemented with OHP Plus.	YES	$350.00, No Charge	100.00%
Orthodontia - Adult	NO
Orthodontia - Child Exclusions: See Policy for detailed exclusions Supplemented with OHP Plus.	YES	$350.00, No Charge	100.00%
Routine Dental Services (Adult) Limit: 1.0 Procedure(s) per 6 Months Exclusions: See Policy for detailed exclusions	YES	$0.00, No Charge	100.00%

Super SmartSmile - EC Health Insurance Plan Variant 25486OR0020002-00 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 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	0.00929
First Tier Utilization	100%
HIOS Product ID	25486OR002
Import Date	8/16/2022 20:01
Inpatient Copayment Maximum Days	0
Guaranteed Rate	Guaranteed Rate
New/Existing Plan	Existing
Issuer ID	25486
Issuer Marketplace Marketing Name	Dental Health Services
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	per person not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual	Not Applicable
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	$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	No
Network ID	ORN001
Out of Country Coverage	Yes
Out of Country Coverage Description	Emergency coverage only - for the relief of pain, swelling, and bleeding.
Out of Service Area Coverage	Yes
Out of Service Area Coverage Description	Emergency coverage only - for the relief of pain, swelling, and bleeding.
Plan Brochure	URL
Plan Effective Date	1/1/2023
Plan Expiration Date	12/31/2023
Plan ID (Standard Component ID with Variant)	25486OR0020002-00
Plan Marketing Name	Super SmartSmile - EC
Plan Type	EPO
Plan Variant Marketing Name	Super SmartSmile - EC
QHP/Non QHP	Both
Service Area ID	ORS001
Source Name	SERFF
Plan ID	25486OR0020002
State Code	OR
URL for Enrollment Payment	URL

Copay & Coinsurance of Super SmartSmile - EC Health Insurance Plan, 25486OR0020002

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

Frequently Asked Questions(FAQ) about Super SmartSmile - EC, 25486OR0020002 Health Insurance Plan, 25486OR0020002

Does Super SmartSmile - EC Health Insurance Plan, 25486OR0020002 support Mail Ordering?

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

Does (25486OR0020002) Health Insurance Plan, Variant (25486OR0020002-00) have Out Of Country Coverage?

Yes. Details: Emergency coverage only - for the relief of pain, swelling, and bleeding.

Does (25486OR0020002) Health Insurance Plan, Variant (25486OR0020002-00) have Out of Service Area Coverage?