Delta Dental PPO Plus Premier-Federally Compliant Plan - 77760OK0020005 Health Insurance Plan
Delta Dental of Oklahoma health insurance plan with the Plan ID 77760OK0020005. The plan is called Delta Dental PPO Plus Premier-Federally Compliant Plan.
| Health Insurance Plan ID | 77760OK0020005 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Oklahoma | ||||||||||||||||||
| Health Insurance Issuer | Delta Dental of Oklahoma | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 77760OK0020005-00 | ||||||||||||||||||
| Provider Network(s) | ['OKN001'] | ||||||||||||||||||
| 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, 06 Aug 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan, 77760OK0020005-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Exclusions: Deductible applies. For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19. Deductible applies. For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19. |
YES | No Charge after deductible, 20.00% Coinsurance after deductible |
No Charge after deductible, 20.00% Coinsurance after deductible |
| Basic Dental Care - Child
Exclusions: Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19. Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19. |
YES | No Charge after deductible, 20.00% Coinsurance after deductible |
No Charge after deductible, 20.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months Exclusions: MOOP only applies to covered persons through the end of the month in which they turn 19. MOOP only applies to covered persons through the end of the month in which they turn 19. |
YES | No Charge |
No Charge |
| Major Dental Care - Adult
Exclusions: Deductible applies. For covered persons over the age 18 there is a 12 month waiting period on Class III - Major services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19. Deductible applies. For covered persons over the age 18 there is a 12 month waiting period on Class III - Major services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19. |
YES | No Charge after deductible, 50.00% Coinsurance after deductible |
No Charge after deductible, 50.00% Coinsurance after deductible |
| Major Dental Care - Child
Exclusions: Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19. Deductible applies. MOOP only applies to covered persons through the end of the month in which they turn 19. |
YES | No Charge after deductible, 50.00% Coinsurance after deductible |
No Charge after deductible, 50.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Exclusions: Applies to medically necessary procedures only. MOOP only applies to covered persons through the end of the month in which they turn 19. Applies to medically necessary procedures only. MOOP only applies to covered persons through the end of the month in which they turn 19. |
YES | No Charge, 50.00% |
No Charge, 50.00% |
| Routine Dental Services (Adult)
Limit: 1.0 Visit(s) per 6 Months Exclusions: Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19. |
YES | No Charge |
No Charge |
Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan Variant 77760OK0020005-00 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 |
| First Tier Utilization | 100% |
| HIOS Product ID | 77760OK002 |
| Import Date | 2024-08-06 01:01:33 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 77760 |
| Issuer Marketplace Marketing Name | Delta Dental of Oklahoma |
| 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 | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $50 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $50 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | $50 per person |
| Medical EHB Deductible, Out of Network, Individual | $50 |
| 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 | OKN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | All benefits that are offered on the plan are available out of country. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | All benefits that are offered on the plan are available out of the service area. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 77760OK0020005-00 |
| Plan Level Exclusions | For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services and a 12 month waiting period on Class III - Major services. MOOP only applies to covered persons age 0 through 18. |
| Plan Marketing Name | Delta Dental PPO Plus Premier-Federally Compliant Plan |
| Plan Type | PPO |
| Plan Variant Marketing Name | Delta Dental PPO Plus Premier-Federally Compliant Plan |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | OKS001 |
| Source Name | HIOS |
| Plan ID | 77760OK0020005 |
| State Code | OK |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
Copay & Coinsurance of Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan, 77760OK0020005
| 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 Plus Premier-Federally Compliant Plan, 77760OK0020005 Health Insurance Plan, 77760OK0020005
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Does Delta Dental PPO Plus Premier-Federally Compliant Plan Health Insurance Plan, 77760OK0020005 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (77760OK0020005) Health Insurance Plan, Variant (77760OK0020005-00) have Out Of Country Coverage?
Does (77760OK0020005) Health Insurance Plan, Variant (77760OK0020005-00) 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