Unum MI EHB Plan 2 - 53678MI0070001 Health Insurance Plan
AlwaysCare Benefits, Inc. health insurance plan with the Plan ID 53678MI0070001. The plan is called Unum MI EHB Plan 2.
| Health Insurance Plan ID | 53678MI0070001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Michigan | ||||||||||||||||||
| Health Insurance Issuer | AlwaysCare Benefits, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 53678MI0070001-00 | ||||||||||||||||||
| Provider Network(s) | ['MIN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Sun, 14 Aug 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
Benefits of Unum MI EHB Plan 2 Health Insurance Plan, 53678MI0070001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
Limit: 1500.0 Dollars per Benefit Period |
YES | 0.00% |
0.00% |
| Basic Dental Care - Adult
Limit: 1500.0 Dollars per Benefit Period |
YES | 10.00% Coinsurance after deductible |
10.00% Coinsurance after deductible |
| Basic Dental Care - Child
MIChild, Pages 8-9 |
YES | 10.00% Coinsurance after deductible |
10.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year MIChild, Pages 8-9 |
YES | 0.00% |
0.00% |
| Major Dental Care - Adult
Limit: 1500.0 Dollars per Benefit Period |
YES | 40.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
| Major Dental Care - Child
MIChild, Pages 8-9 |
YES | 40.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Limit: 1000.0 Dollars per Lifetime |
YES | 50.00% |
50.00% |
| Routine Dental Services (Adult)
Limit: 1500.0 Dollars per Benefit Period |
YES | 0.00% |
0.00% |
Unum MI EHB Plan 2 Health Insurance Plan Variant 53678MI0070001-00 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 High Off Exchange Plan |
| Dental Only Plan | Yes |
| First Tier Utilization | 100% |
| HIOS Product ID | 53678MI007 |
| Import Date | 8/14/2022 20:00 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Estimated Rate |
| New/Existing Plan | New |
| Issuer ID | 53678 |
| Issuer Marketplace Marketing Name | AlwaysCare Benefits, Inc. |
| 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 | 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 | $150 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $50 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $50 |
| Medical EHB Deductible, Out of Network, Family Per Group | $150 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $50 per person |
| Medical EHB Deductible, Out of Network, Individual | $50 |
| 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 | High |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | MIN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code. |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 53678MI0070001-00 |
| Plan Marketing Name | Unum MI EHB Plan 2 |
| Plan Type | PPO |
| Plan Variant Marketing Name | Unum MI EHB Plan 2 |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | MIS001 |
| Source Name | SERFF |
| Plan ID | 53678MI0070001 |
| State Code | MI |
Copay & Coinsurance of Unum MI EHB Plan 2 Health Insurance Plan, 53678MI0070001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Unum MI EHB Plan 2, 53678MI0070001 Health Insurance Plan, 53678MI0070001
-
Does Unum MI EHB Plan 2 Health Insurance Plan, 53678MI0070001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (53678MI0070001) Health Insurance Plan, Variant (53678MI0070001-00) have Out Of Country Coverage?
Yes. Details: Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.
Does (53678MI0070001) Health Insurance Plan, Variant (53678MI0070001-00) have Out of Service Area Coverage?
Yes. Details: Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 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