Choice PPO Preventive - 74243FL0010004 Health Insurance Plan

Dominion Dental Services, Inc. health insurance plan with the Plan ID 74243FL0010004. The plan is called Choice PPO Preventive.

Health Insurance Plan ID

74243FL0010004

Health Insurance Plan Year

2024

State

Florida

Health Insurance Issuer

Dominion Dental Services, Inc.

Plan Marketing Materials URL

Marketing URL

Health Insurance Plan Variant

74243FL0010004-01

Provider Network(s)

CHOICE

In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT).

Providers	Florida	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 - 74243FL0010004-00

Standard On Exchange Plan - 74243FL0010004-01

Last Plan Update Date

Wed, 01 Nov 2023 00:00 GMT

Last Import Date

Thu, 21 Nov 2024 00:44 GMT

Benefits of Choice PPO Preventive Health Insurance Plan, 74243FL0010004-01

Benefit	Covered	In Network	Out Of Network
Accidental Dental	YES	0.00% Coinsurance after deductible	20.00% Coinsurance after deductible
Basic Dental Care - Adult	NO
Basic Dental Care - Child Benefit limitations may apply to individual services. Max Out of Pocket is $400 per child up to $800 per family	YES	65.00% Coinsurance after deductible	80.00% Coinsurance after deductible
Dental Check-Up for Children Limit: 1.0 Visit(s) per 6 Months 1 per 6 months Includes coverage for D1110, D1120, D1203, D1204, D1206, and D1208.	YES	100.00%	80.00%
Major Dental Care - Adult	NO
Major Dental Care - Child Benefit limitations may apply to individual services.	YES	75.00% Coinsurance after deductible	90.00% Coinsurance after deductible
Orthodontia - Adult	NO
Orthodontia - Child	YES	50.00% Coinsurance after deductible	70.00% Coinsurance after deductible
Routine Dental Services (Adult) Subject to deductible of $50/individual and $150/three or more adults. Benefit limitations may apply to individual services.	YES	0.00% Coinsurance after deductible	20.00% Coinsurance after deductible

Choice PPO Preventive Health Insurance Plan Variant 74243FL0010004-01 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	74243FL001
Import Date	2023-11-01 01:02:11
Inpatient Copayment Maximum Days	0
Guaranteed Rate	Guaranteed Rate
New/Existing Plan	New
Issuer ID	74243
Issuer Marketplace Marketing Name	Dominion National
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	$200 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person	$100 per person
Medical EHB Deductible, Combined In/Out of Network, Individual	$100
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	$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	FLN001
Out of Country Coverage	Yes
Out of Country Coverage Description	Standard Out of Network PPO Benefits
Out of Service Area Coverage	Yes
Out of Service Area Coverage Description	Standard Out of Network PPO Benefits
Plan Brochure	URL
Plan Effective Date	2024-01-01
Plan Expiration Date	2024-12-31
Plan ID (Standard Component ID with Variant)	74243FL0010004-01
Plan Marketing Name	Choice PPO Preventive
Plan Type	PPO
Plan Variant Marketing Name	Choice PPO Preventive
QHP/Non QHP	Both
Service Area ID	FLS001
Source Name	HIOS
Plan ID	74243FL0010004
State Code	FL

Copay & Coinsurance of Choice PPO Preventive Health Insurance Plan, 74243FL0010004

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

Frequently Asked Questions(FAQ) about Choice PPO Preventive, 74243FL0010004 Health Insurance Plan, 74243FL0010004

Does Choice PPO Preventive Health Insurance Plan, 74243FL0010004 support Mail Ordering?

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

Does (74243FL0010004) Health Insurance Plan, Variant (74243FL0010004-01) have Out Of Country Coverage?

Yes. Details: Standard Out of Network PPO Benefits

Does (74243FL0010004) Health Insurance Plan, Variant (74243FL0010004-01) have Out of Service Area Coverage?