Delta Dental PPO 1500 Plan - 21989AK0050002 Health Insurance Plan

Oregon Dental Service health insurance plan with the Plan ID 21989AK0050002. The plan is called Delta Dental PPO 1500 Plan.

Health Insurance Plan ID

21989AK0050002

Health Insurance Plan Year

2025

State

Alaska

Health Insurance Issuer

Oregon Dental Service

Plan Marketing Materials URL

Marketing URL

Health Insurance Plan Variant

21989AK0050002-00

Provider Network(s)

PREFERRED DELTA-DENTAL-PPO

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	Alaska	All US States
All	150	186
PCP	N/A	N/A
Allergy	N/A	N/A
OB/GYN	N/A	N/A
Dentists	79	101

Available Variants of the Health Plan

Standard Off Exchange Plan - 21989AK0050002-00

Standard On Exchange Plan - 21989AK0050002-01

Last Plan Update Date

Thu, 29 Aug 2024 00:00 GMT

Last Import Date

Thu, 21 Nov 2024 00:44 GMT

Benefits of Delta Dental PPO 1500 Plan Health Insurance Plan, 21989AK0050002-00

Benefit	Covered	In Network	Out Of Network
Accidental Dental	NO
Basic Dental Care - Adult Limit: 1500.0 Dollars per Year See policy for other limits	YES	20.00% Coinsurance after deductible	50.00% Coinsurance after deductible
Basic Dental Care - Child See policy for limits	YES	50.00% Coinsurance after deductible	70.00% Coinsurance after deductible
Dental Check-Up for Children See policy for limits	YES	0.00%	50.00%
Major Dental Care - Adult Limit: 1500.0 Dollars per Year See policy for other limits	YES	50.00% Coinsurance after deductible	50.00% Coinsurance after deductible
Major Dental Care - Child See policy for limits	YES	70.00% Coinsurance after deductible	70.00% Coinsurance after deductible
Orthodontia - Adult	NO
Orthodontia - Child For medically necessary only	YES	70.00% Coinsurance after deductible	70.00% Coinsurance after deductible
Routine Dental Services (Adult) Limit: 1500.0 Dollars per Year See policy for other limits	YES	0.00%	50.00%

Delta Dental PPO 1500 Plan Health Insurance Plan Variant 21989AK0050002-00 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	21989AK005
Import Date	2024-08-29 01:02:15
Inpatient Copayment Maximum Days	0
Guaranteed Rate	Guaranteed Rate
New/Existing Plan	Existing
Issuer ID	21989
Issuer Marketplace Marketing Name	Delta Dental of Alaska
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	$150 per group
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	$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	Yes
Network ID	AKN004
Out of Country Coverage	Yes
Out of Country Coverage Description	Out-of-network benefits
Out of Service Area Coverage	Yes
Out of Service Area Coverage Description	Out-of-network benefits
Plan Brochure	URL
Plan Effective Date	2025-01-01
Plan Expiration Date	2025-12-31
Plan ID (Standard Component ID with Variant)	21989AK0050002-00
Plan Marketing Name	Delta Dental PPO 1500 Plan
Plan Type	PPO
Plan Variant Marketing Name	Delta Dental PPO 1500 Plan
QHP/Non QHP	Both
Service Area ID	AKS004
Source Name	HIOS
Plan ID	21989AK0050002
State Code	AK
URL for Enrollment Payment	URL

Copay & Coinsurance of Delta Dental PPO 1500 Plan Health Insurance Plan, 21989AK0050002

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

Frequently Asked Questions(FAQ) about Delta Dental PPO 1500 Plan, 21989AK0050002 Health Insurance Plan, 21989AK0050002

Does Delta Dental PPO 1500 Plan Health Insurance Plan, 21989AK0050002 support Mail Ordering?

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

Does (21989AK0050002) Health Insurance Plan, Variant (21989AK0050002-00) have Out Of Country Coverage?

Yes. Details: Out-of-network benefits

Does (21989AK0050002) Health Insurance Plan, Variant (21989AK0050002-00) have Out of Service Area Coverage?