Delta Dental EPO - 28415OR0300001 Health Insurance Plan
Oregon Dental Service, DBA Delta Dental Plan of Oregon health insurance plan with the Plan ID 28415OR0300001. The plan is called Delta Dental EPO.
| Health Insurance Plan ID | 28415OR0300001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | Oregon Dental Service, DBA Delta Dental Plan of Oregon | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 28415OR0300001-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Fri, 17 May 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of Delta Dental EPO Health Insurance Plan, 28415OR0300001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Limit: 1500.0 Dollars per Year Exclusions: See policy for exclusions See policy for limits. 6-month exclusion period for age 19 and over if member does not have 12 continuous months of prior dental coverage with no more than a 90-day break in coverage from the end of the old policy to the effective date of the new policy. |
YES | 30.00% |
100.00% |
| Basic Dental Care - Child
Exclusions: See policy for exclusions See policy for limits |
YES | 30.00% |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Exam(s) per 6 Months Exclusions: See policy for exclusions See policy for limits |
YES | 0.00% |
100.00% |
| Major Dental Care - Adult
Limit: 1500.0 Dollars per Year Exclusions: See policy for exclusions See policy for limits. 12-month exclusion period for age 19 and over if member does not have 12 continuous months of prior dental coverage with no more than a 90-day break in coverage from the end of the old policy to the effective date of the new policy. |
YES | 50.00% |
100.00% |
| Major Dental Care - Child
Exclusions: See policy for exclusions See policy for limits |
YES | 50.00% |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Exclusions: See policy for exclusions For under age 19 and necessary to treat cleft palate with or without cleft lip. |
YES | 50.00% |
100.00% |
| Routine Dental Services (Adult)
Limit: 1500.0 Dollars per Year Exclusions: See policy for exclusions See policy for limits |
YES | 0.00% |
100.00% |
Delta Dental EPO Health Insurance Plan Variant 28415OR0300001-00 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 Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard High Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1.0 |
| First Tier Utilization | 100% |
| HIOS Product ID | 28415OR030 |
| Import Date | 2024-05-17 20:01:51 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 28415 |
| Issuer Marketplace Marketing Name | Delta Dental Plan of Oregon |
| 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 | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 | $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 | High |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ORN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | For emergency palliative care only |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 28415OR0300001-00 |
| Plan Marketing Name | Delta Dental EPO |
| Plan Type | EPO |
| Plan Variant Marketing Name | Delta Dental EPO |
| QHP/Non QHP | Both |
| Service Area ID | ORS003 |
| Source Name | SERFF |
| Plan ID | 28415OR0300001 |
| State Code | OR |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Delta Dental EPO Health Insurance Plan, 28415OR0300001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Delta Dental EPO, 28415OR0300001 Health Insurance Plan, 28415OR0300001
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Does Delta Dental EPO Health Insurance Plan, 28415OR0300001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (28415OR0300001) Health Insurance Plan, Variant (28415OR0300001-00) have Out Of Country Coverage?
Does (28415OR0300001) Health Insurance Plan, Variant (28415OR0300001-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 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