Delta Dental Individual and Family Premier Value - 11821MA0030004 Health Insurance Plan

11821 health insurance plan with the Plan ID 11821MA0030004. The plan is called Delta Dental Individual and Family Premier Value.

Health Insurance Plan ID 11821MA0030004
Health Insurance Plan Year 2024
State Massachusetts
Health Insurance Issuer 11821
Health Insurance Plan Variant 11821MA0030004-01
Provider Network(s) ['MAN002']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 GMT).

Providers Massachusetts 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 On Exchange Plan - 11821MA0030004-01

Last Plan Update Date Mon, 12 Feb 2024 00:00 GMT
Last Import Date Tue, 17 Dec 2024 06:12 GMT

Delta Dental Individual and Family Premier Value Health Insurance Plan Variant 11821MA0030004-01 Attributes

Plan Attribute Value
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 100.00%
First Tier Utilization 100%
HIOS Product ID 11821MA003
Import Date 2/12/2024
Guaranteed Rate Guaranteed Rate
IsItANewPlan Existing
Issuer ID 11821
Market Coverage Individual
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family per person not applicable | per group 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 person not applicable | per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Family $50 per person | $150 per group
Medical EHB Deductible, In Network (Tier 1), Individual $50
Medical EHB Deductible, Out of Network, Family $50 per person | $150 per group
Medical EHB Deductible, Out of Network, Individual $50
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family $350 per person | $700 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $350
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family per person not applicable | per group 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 MAN002
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Only.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description National netwrok coverage
Plan Effective Date 1/1/2024
Plan Expiration Date 12/31/2024
Plan ID (Standard Component ID with Variant) 11821MA0030004-01
Plan Marketing Name Delta Dental Individual and Family Premier Value
Plan Type PPO
Plan Variant Marketing Name Delta Dental Individual and Family Premier Value
QHP/Non QHP Both
Service Area ID MAS001
Source Name SERFF
Plan ID 11821MA0030004
State Code MA
Version Number 1
Wellness Program Offered No

Copay & Coinsurance of Delta Dental Individual and Family Premier Value Health Insurance Plan, 11821MA0030004

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

Frequently Asked Questions(FAQ) about Delta Dental Individual and Family Premier Value, 11821MA0030004 Health Insurance Plan, 11821MA0030004

  • Does Delta Dental Individual and Family Premier Value Health Insurance Plan, 11821MA0030004 support Mail Ordering?

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

  • Does (11821MA0030004) Health Insurance Plan, Variant (11821MA0030004-01) have Out Of Country Coverage?

    Yes. Details: Emergency Only.

    Does (11821MA0030004) Health Insurance Plan, Variant (11821MA0030004-01) have Out of Service Area Coverage?

    Yes. Details: National netwrok coverage

 

Disclaimer: This is based on the import(Date: Tue, 17 Dec 2024 06:12 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