Delta Dental Platinum + Delta Dental Kids Plan - 27882ND0080001 Health Insurance Plan

Delta Dental of Minnesota health insurance plan with the Plan ID 27882ND0080001. The plan is called Delta Dental Platinum + Delta Dental Kids Plan.

Health Insurance Plan ID

27882ND0080001

Health Insurance Plan Year

2024

State

North Dakota

Health Insurance Issuer

Delta Dental of Minnesota

Plan Marketing Materials URL

Marketing URL

Health Insurance Plan Variant

27882ND0080001-00

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: Thu, 21 Nov 2024 00:44 GMT).

Providers	North Dakota	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 - 27882ND0080001-00

Standard On Exchange Plan - 27882ND0080001-01

Last Plan Update Date

Fri, 11 Aug 2023 00:00 GMT

Last Import Date

Thu, 21 Nov 2024 00:44 GMT

Benefits of Delta Dental Platinum + Delta Dental Kids Plan Health Insurance Plan, 27882ND0080001-00

Benefit	Covered	In Network	Out Of Network
Accidental Dental	NO
Basic Dental Care - Adult	YES	20.00% Coinsurance after deductible	20.00% Coinsurance after deductible
Basic Dental Care - Child Exclusions: Dependent age limited to the end of the year in which they turn 19	YES	50.00% Coinsurance after deductible	50.00% Coinsurance after deductible
Dental Check-Up for Children Limit: 2.0 Visit(s) per Year Exclusions: Dependent age limited to the end of the year in which they turn 19	YES	No Charge	No Charge
Major Dental Care - Adult	YES	50.00% Coinsurance after deductible	50.00% Coinsurance after deductible
Major Dental Care - Child Exclusions: Dependent age limited to the end of the year in which they turn 19	YES	50.00% Coinsurance after deductible	50.00% Coinsurance after deductible
Orthodontia - Adult	NO
Orthodontia - Child Exclusions: Dependent age limited to the end of the year in which they turn 19	YES	50.00% Coinsurance after deductible	50.00% Coinsurance after deductible
Routine Dental Services (Adult) Limit: 2.0 Visit(s) per Year	YES	No Charge	No Charge

Delta Dental Platinum + Delta Dental Kids Plan Health Insurance Plan Variant 27882ND0080001-00 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	2024
Child-Only Offering	Allows Adult and Child-Only
Composite Rating Offered	No
CSR Variation Type	Standard Low Off Exchange Plan
Dental Only Plan	Yes
EHB Apportionment for Pediatric Dental	1.0
First Tier Utilization	100%
HIOS Product ID	27882ND008
Import Date	2023-08-11 01:01:52
Inpatient Copayment Maximum Days	0
Guaranteed Rate	Guaranteed Rate
New/Existing Plan	Existing
Issuer ID	27882
Issuer Marketplace Marketing Name	Delta Dental of Minnesota
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	$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	$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	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 Country coverage
Plan Brochure	URL
Plan Effective Date	2024-01-01
Plan Expiration Date	2024-12-31
Plan ID (Standard Component ID with Variant)	27882ND0080001-00
Plan Marketing Name	Delta Dental Platinum + Delta Dental Kids Plan
Plan Type	PPO
Plan Variant Marketing Name	Delta Dental Platinum + Delta Dental Kids Plan
QHP/Non QHP	Both
Service Area ID	NDS001
Source Name	HIOS
Plan ID	27882ND0080001
State Code	ND
URL for Enrollment Payment	URL

Copay & Coinsurance of Delta Dental Platinum + Delta Dental Kids Plan Health Insurance Plan, 27882ND0080001

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

Frequently Asked Questions(FAQ) about Delta Dental Platinum + Delta Dental Kids Plan, 27882ND0080001 Health Insurance Plan, 27882ND0080001

Does Delta Dental Platinum + Delta Dental Kids Plan Health Insurance Plan, 27882ND0080001 support Mail Ordering?

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

Does (27882ND0080001) Health Insurance Plan, Variant (27882ND0080001-00) have Out Of Country Coverage?

Yes. Details: Similar benefits as In Country coverage

Does (27882ND0080001) Health Insurance Plan, Variant (27882ND0080001-00) have Out of Service Area Coverage?