Arizona Dental Insurance Service, Inc. health insurance plan with the Plan ID 30045AZ0010021. The plan is called Delta Dental Essential Plan - Family or Child Only.
Health Insurance Plan ID | 30045AZ0010021 | ||||||||||||||||||
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Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Arizona | ||||||||||||||||||
Health Insurance Issuer | Arizona Dental Insurance Service, Inc. | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 30045AZ0010021-01 | ||||||||||||||||||
Provider Network(s) | DELTA-DENTAL-PPO-AND-DELTA-DENTAL-PREMIER | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 27 Aug 2024 05:58 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Thu, 25 Apr 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 27 Aug 2024 05:58 GMT |
Benefit | Covered | In Network | Out Of Network |
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Accidental Dental
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NO | ||
Basic Dental Care - Adult
Exclusions: For a full list of exclusions, please see the summary of benefits. |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Basic Dental Care - Child
|
YES | 40.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
Dental Check-Up for Children
|
YES | 0.00% Coinsurance after deductible |
0.00% Coinsurance after deductible |
Major Dental Care - Adult
|
NO | ||
Major Dental Care - Child
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Routine Dental Services (Adult)
Limit: 1.0 Visit(s) per 6 Months Exclusions: For a full list of exclusions, please see the summary of benefits. 1 dental check-up per 6 months |
YES | 0.00% Coinsurance after deductible |
20.00% 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 Low On Exchange Plan |
Dental Only Plan | Yes |
EHB Apportionment for Pediatric Dental | 1.0 |
First Tier Utilization | 100% |
HIOS Product ID | 30045AZ001 |
Import Date | 2024-04-25 04:01:32 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 30045 |
Issuer Marketplace Marketing Name | Delta Dental of Arizona |
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 | $75 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $75 |
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 | No |
Network ID | AZN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | If you are in a foreign country and need emergency dental treatment, you are covered with Delta Dental. |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | If you are traveling out of state and need dental treatment, Delta Dental is there to cover you with America's largest network of dentists. |
Plan Brochure | URL |
Plan Effective Date | 2024-01-01 |
Plan Expiration Date | 2024-12-31 |
Plan ID (Standard Component ID with Variant) | 30045AZ0010021-01 |
Plan Level Exclusions | For a full list of exclusions, please see the summary of benefits. |
Plan Marketing Name | Delta Dental Essential Plan - Family or Child Only |
Plan Type | PPO |
Plan Variant Marketing Name | Delta Dental Essential Plan - Family or Child Only |
QHP/Non QHP | Both |
Service Area ID | AZS001 |
Source Name | HIOS |
Plan ID | 30045AZ0010021 |
State Code | AZ |
URL for Enrollment Payment | URL |
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, 27 Aug 2024 05:58 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