Delta Dental PPO Basic Plan for Families - 71788MT0010009 Health Insurance Plan
Delta Dental Insurance Company health insurance plan with the Plan ID 71788MT0010009. The plan is called Delta Dental PPO Basic Plan for Families.
| Health Insurance Plan ID | 71788MT0010009 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Montana | ||||||||||||||||||
| Health Insurance Issuer | Delta Dental Insurance Company | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 71788MT0010009-01 | ||||||||||||||||||
| Provider Network(s) | 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). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Tue, 15 Aug 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of Delta Dental PPO Basic Plan for Families Health Insurance Plan, 71788MT0010009-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
|
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Basic Dental Care - Child
|
YES | 50.00% Coinsurance after deductible |
50.00% 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
Orthodontia for children is only covered when medically necessary. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
|
YES | 0.00% Coinsurance after deductible |
0.00% Coinsurance after deductible |
Delta Dental PPO Basic Plan for Families Health Insurance Plan Variant 71788MT0010009-01 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 On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1.0 |
| First Tier Utilization | 100% |
| HIOS Product ID | 71788MT001 |
| Import Date | 2023-08-15 20:02:25 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 71788 |
| Issuer Marketplace Marketing Name | Delta Dental |
| 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 | $85 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $85 |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $55 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $55 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | $85 per person |
| Medical EHB Deductible, Out of Network, Individual | $85 |
| 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 | $800 per group |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person | $400 per person |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual | $400 |
| Metal Level | Low |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | MTN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Nationwide Network |
| Plan Brochure | URL |
| Plan Effective Date | 2024-01-01 |
| Plan Expiration Date | 2024-12-31 |
| Plan ID (Standard Component ID with Variant) | 71788MT0010009-01 |
| Plan Marketing Name | Delta Dental PPO Basic Plan for Families |
| Plan Type | PPO |
| Plan Variant Marketing Name | Delta Dental PPO Basic Plan for Families |
| QHP/Non QHP | On the Exchange |
| Service Area ID | MTS001 |
| Source Name | SERFF |
| Plan ID | 71788MT0010009 |
| State Code | MT |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Delta Dental PPO Basic Plan for Families Health Insurance Plan, 71788MT0010009
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Delta Dental PPO Basic Plan for Families, 71788MT0010009 Health Insurance Plan, 71788MT0010009
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Does Delta Dental PPO Basic Plan for Families Health Insurance Plan, 71788MT0010009 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (71788MT0010009) Health Insurance Plan, Variant (71788MT0010009-01) have Out Of Country Coverage?
Does (71788MT0010009) Health Insurance Plan, Variant (71788MT0010009-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 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