Delta Dental of Minnesota health insurance plan with the Plan ID 27882ND0170001. The plan is called Delta Dental Kids Plan.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.00% of the costs of all covered benefits (according to the Issuer).
Health Insurance Plan ID | 27882ND0170001 | ||||||||||||||||||
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Health Insurance Plan Year | 2022 | ||||||||||||||||||
State | North Dakota | ||||||||||||||||||
Health Insurance Issuer | Delta Dental of Minnesota | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 27882ND0170001-00 | ||||||||||||||||||
Provider Network(s) | ['NDN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Sep 2024 06:34 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Thu, 22 Jul 2021 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 10 Sep 2024 06:34 GMT |
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 | 2022 |
Child-Only Offering | Allows Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard Low Off Exchange Plan |
Dental Only Plan | Yes |
First Tier Utilization | 100% |
HIOS Product ID | 27882ND017 |
Import Date | 7/22/2021 1:06 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Estimated Rate |
New/Existing Plan | Existing |
Issuer Actuarial Value | 70.00% |
Issuer ID | 27882 |
Issuer Marketplace Marketing Name | Delta Dental of Minnesota |
Market Coverage | SHOP (Small Group) |
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 | $50 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $50 |
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 | $700 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $350 per person |
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 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 | NDN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Similar benefits as In Country coverage |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | similar benefits as in service area |
Plan Effective Date | 1/1/2022 |
Plan Expiration Date | 12/31/2022 |
Plan ID (Standard Component ID with Variant) | 27882ND0170001-00 |
Plan Marketing Name | Delta Dental Kids Plan |
Plan Type | PPO |
Plan Variant Marketing Name | Delta Dental Kids Plan |
QHP/Non QHP | Off the Exchange |
Service Area ID | NDS001 |
Source Name | HIOS |
Plan ID | 27882ND0170001 |
State Code | ND |
URL for Summary of Benefits & Coverage | 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, 10 Sep 2024 06:34 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