BlueCare Dental 4 Kids℠ 1B - 87571OK0390004 Health Insurance Plan

Blue Cross Blue Shield of Oklahoma health insurance plan with the Plan ID 87571OK0390004. The plan is called BlueCare Dental 4 Kids℠ 1B.

Health Insurance Plan ID 87571OK0390004
Health Insurance Plan Year 2025
State Oklahoma
Health Insurance Issuer Blue Cross Blue Shield of Oklahoma
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 87571OK0390004-00
Provider Network(s) PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT).

Providers Oklahoma All US States
All 1454 118373
PCP 1 60
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 933 77980
Available Variants of the Health Plan

Standard Off Exchange Plan - 87571OK0390004-00

Standard On Exchange Plan - 87571OK0390004-01

Last Plan Update Date Tue, 22 Oct 2024 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Benefits of BlueCare Dental 4 Kids℠ 1B Health Insurance Plan, 87571OK0390004-00

Benefit Covered In Network Out Of Network
Accidental Dental
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
YES

50.00% Coinsurance after deductible

70.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

YES

20.00%

40.00%
Major Dental Care - Adult
NO
Major Dental Care - Child
YES

50.00% Coinsurance after deductible

70.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child
YES

50.00%

70.00%
Routine Dental Services (Adult)
NO

BlueCare Dental 4 Kids℠ 1B Health Insurance Plan Variant 87571OK0390004-00 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
EHB Apportionment for Pediatric Dental 1.0
First Tier Utilization 100%
HIOS Product ID 87571OK039
Import Date 2024-10-22 01:01:28
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 87571
Issuer Marketplace Marketing Name Blue Cross and Blue Shield of Oklahoma
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 $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 $850 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $425 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $425
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 OKN001
Out of Country Coverage Yes
Out of Country Coverage Description Services out of the country will be treated as Out-of-Network and member will have to pay the provider and file for reimbursement as an Out-of-Network claim.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are Participating Providers) with the Dental Network partners within our BlueCare Dental Network. In some instances, you may obtain care from Non-Participating Providers.
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 87571OK0390004-00
Plan Marketing Name BlueCare Dental 4 Kids℠ 1B
Plan Type PPO
Plan Variant Marketing Name BlueCare Dental 4 Kids℠ 1B
QHP/Non QHP Both
Service Area ID OKS001
Source Name HIOS
Plan ID 87571OK0390004
State Code OK
URL for Enrollment Payment URL

Copay & Coinsurance of BlueCare Dental 4 Kids℠ 1B Health Insurance Plan, 87571OK0390004

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

Frequently Asked Questions(FAQ) about BlueCare Dental 4 Kids℠ 1B, 87571OK0390004 Health Insurance Plan, 87571OK0390004

  • Does BlueCare Dental 4 Kids℠ 1B Health Insurance Plan, 87571OK0390004 support Mail Ordering?

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

  • Does (87571OK0390004) Health Insurance Plan, Variant (87571OK0390004-00) have Out Of Country Coverage?

    Yes. Details: Services out of the country will be treated as Out-of-Network and member will have to pay the provider and file for reimbursement as an Out-of-Network claim.

    Does (87571OK0390004) Health Insurance Plan, Variant (87571OK0390004-00) have Out of Service Area Coverage?

    Yes. Details: When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are Participating Providers) with the Dental Network partners within our BlueCare Dental Network. In some instances, you may obtain care from Non-Participating Providers.

 

Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 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