Anthem Blue Cross and Blue Shield health insurance plan with the Plan ID 49046GA0540004. The plan is called Anthem Dental Family Enhanced.
Health Insurance Plan ID | 49046GA0540004 | ||||||||||||||||||
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Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Georgia | ||||||||||||||||||
Health Insurance Issuer | Anthem Blue Cross and Blue Shield | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 49046GA0540004-01 | ||||||||||||||||||
Provider Network(s) | PARTICIPATING | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 20 Aug 2024 06:14 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Thu, 17 Aug 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 20 Aug 2024 06:14 GMT |
Benefit | Covered | In Network | Out Of Network |
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Accidental Dental
|
NO | ||
Basic Dental Care - Adult
6 month waiting period |
YES | 20.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
Basic Dental Care - Child
|
YES | 20.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
Cosmetic Orthodontia
Limit: 1000.0 Dollars per Lifetime 12 month waiting period. Child Only |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year |
YES | No Charge after deductible |
20.00% Coinsurance after deductible |
Major Dental Care - Adult
12 month waiting period |
YES | 50.00% Coinsurance after deductible |
75.00% Coinsurance after deductible |
Major Dental Care - Child
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
Dentally Necessary Orthodontia: No Waiting Period. Cosmetic Orthodontia Coverage: 12 month waiting period with $1000 Lifetime Maximum. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Routine Dental Services (Adult)
|
YES | No Charge after deductible |
50.00% Coinsurance after deductible |
Plan Attribute | Value |
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Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
Business Year | 2024 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard High On Exchange Plan |
Dental Only Plan | Yes |
EHB Apportionment for Pediatric Dental | 0.8359 |
First Tier Utilization | 100% |
HIOS Product ID | 49046GA054 |
Import Date | 2023-08-17 20:01:45 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 49046 |
Issuer Marketplace Marketing Name | Anthem Blue Cross and Blue Shield |
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 | $25 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $25 |
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 | High |
Multiple In Network Tiers | No |
National Network | Yes |
Network ID | GAN007 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Out of Country covered services are reimbursed as out-of-network benefits. |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | If a member does not use a network dentist, services will be reimbursed at the out-of-network level. |
Plan Brochure | URL |
Plan Effective Date | 2024-01-01 |
Plan Expiration Date | 2024-12-31 |
Plan ID (Standard Component ID with Variant) | 49046GA0540004-01 |
Plan Marketing Name | Anthem Dental Family Enhanced |
Plan Type | PPO |
Plan Variant Marketing Name | Anthem Dental Family Enhanced |
QHP/Non QHP | Both |
Service Area ID | GAS036 |
Source Name | SERFF |
Plan ID | 49046GA0540004 |
State Code | GA |
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, 20 Aug 2024 06:14 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