Delta Dental of Minnesota health insurance plan with the Plan ID 27882ND0040001. The plan is called Delta Dental Silver + 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 | 27882ND0040001 | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | North Dakota | ||||||||||||||||||
Health Insurance Issuer | Delta Dental of Minnesota | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 27882ND0040001-00 | ||||||||||||||||||
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). |
|
||||||||||||||||||
Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Sun, 26 Mar 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 10 Sep 2024 06:34 GMT |
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
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
|
NO | ||
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: 1.0 Visit(s) per Year |
YES | No Charge |
No Charge |
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 | 2023 |
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 |
First Tier Utilization | 100% |
HIOS Product ID | 27882ND004 |
Import Date | 3/26/2023 12:02 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Estimated Rate |
New/Existing Plan | Existing |
Is a Referral Required for Specialist? | No |
Issuer Actuarial Value | 70.00% |
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 | $750 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $375 per person |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $375 |
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 | 1/1/2023 |
Plan Expiration Date | 12/31/2023 |
Plan ID (Standard Component ID with Variant) | 27882ND0040001-00 |
Plan Marketing Name | Delta Dental Silver + Delta Dental Kids Plan |
Plan Type | PPO |
Plan Variant Marketing Name | Delta Dental Silver + Delta Dental Kids Plan |
QHP/Non QHP | Both |
Service Area ID | NDS001 |
Source Name | HIOS |
Plan ID | 27882ND0040001 |
State Code | ND |
URL for Enrollment Payment | URL |
URL for Summary of Benefits & Coverage | URL |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
---|
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