BlueDental Copayment QF - 30115FL0040001 Health Insurance Plan
Florida Combined Life Insurance Company health insurance plan with the Plan ID 30115FL0040001. The plan is called BlueDental Copayment QF.
| Health Insurance Plan ID | 30115FL0040001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Florida | ||||||||||||||||||
| Health Insurance Issuer | Florida Combined Life Insurance Company | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 30115FL0040001-01 | ||||||||||||||||||
| Provider Network(s) | DENTEMAX-IF-OUTSIDE-OF-FLORIDA ADVANTAGE-PLUS-NETWORK-IF-OUTSIDE-OF-FLORIDA COPAYMENT-NETWORK | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Thu, 07 Dec 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Benefits of BlueDental Copayment QF Health Insurance Plan, 30115FL0040001-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Limit: 1.0 Treatment(s) per Year amalgam filings |
YES | $17.00 Copay after deductible |
40.00% Coinsurance after deductible |
| Basic Dental Care - Child
See Policy for details |
YES | $15.00 Copay after deductible |
40.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Exam(s) per 6 Months routine exams |
YES | No Charge after deductible |
20.00% Coinsurance after deductible |
| Major Dental Care - Adult
Limit: 1.0 Procedure(s) per Year root canal |
YES | $221.00 Copay with deductible |
60.00% Coinsurance after deductible |
| Major Dental Care - Child
See Policy for details |
YES | $36.00 Copay after deductible |
60.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Limit: 1.0 Treatment(s) per Lifetime See Policy for details |
YES | $400.00 Copay after deductible |
70.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
Limit: 2.0 Exam(s) per 6 Months cleaning |
YES | $10.00 |
20.00% |
BlueDental Copayment QF Health Insurance Plan Variant 30115FL0040001-01 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 | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1.0 |
| First Tier Utilization | 100% |
| HIOS Product ID | 30115FL004 |
| Import Date | 2023-12-07 01:02:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 30115 |
| Issuer Marketplace Marketing Name | Florida Combined Life |
| 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 | $25 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $25 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | $25 per person |
| Medical EHB Deductible, Out of Network, Individual | $25 |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | $800 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $400 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $400 |
| 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 | FLN002 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of service area benefits are available as defined in the Policy but may have a higher member cost share |
| Plan Brochure | URL |
| Plan Effective Date | 2024-01-01 |
| Plan Expiration Date | 2024-12-31 |
| Plan ID (Standard Component ID with Variant) | 30115FL0040001-01 |
| Plan Level Exclusions | See Policy for details |
| Plan Marketing Name | BlueDental Copayment QF |
| Plan Type | PPO |
| Plan Variant Marketing Name | BlueDental Copayment QF |
| QHP/Non QHP | Both |
| Service Area ID | FLS001 |
| Source Name | HIOS |
| Plan ID | 30115FL0040001 |
| State Code | FL |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of BlueDental Copayment QF Health Insurance Plan, 30115FL0040001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about BlueDental Copayment QF, 30115FL0040001 Health Insurance Plan, 30115FL0040001
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Does BlueDental Copayment QF Health Insurance Plan, 30115FL0040001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (30115FL0040001) Health Insurance Plan, Variant (30115FL0040001-01) have Out Of Country Coverage?
Does (30115FL0040001) Health Insurance Plan, Variant (30115FL0040001-01) have Out of Service Area Coverage?
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