DeltaCare USA Preferred Plan for Families - 14948UT0040004 Health Insurance Plan

Alpha Dental of Utah, Inc. health insurance plan with the Plan ID 14948UT0040004. The plan is called DeltaCare USA Preferred Plan for Families.

Health Insurance Plan ID 14948UT0040004
Health Insurance Plan Year 2024
State Utah
Health Insurance Issuer Alpha Dental of Utah, Inc.
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 14948UT0040004-01
Provider Network(s) DELTACARE-USA
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 Utah 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 On Exchange Plan - 14948UT0040004-01

Last Plan Update Date Wed, 16 Aug 2023 00:00 GMT
Last Import Date Thu, 21 Nov 2024 00:44 GMT

Benefits of DeltaCare USA Preferred Plan for Families Health Insurance Plan, 14948UT0040004-01

Benefit Covered In Network Out Of Network
Accidental Dental
NO
Basic Dental Care - Adult

Refer to plan summary for specific copay/cost-share information.

YES

$25.00

 100.00%
Basic Dental Care - Child
NO
Dental Check-Up for Children

Limit: 2.0 Procedure(s) per Benefit Period

Routine cleaning, exams, x-rays and fluoride. Sealants once every five years. Refer to plan summary for specific copay/cost-share information.

YES

$5.00

 100.00%
Major Dental Care - Adult

Refer to plan summary for specific copay/cost-share information.

YES

$371.00

 100.00%
Major Dental Care - Child
NO
Orthodontia - Adult

Refer to plan summary for specific copay/cost-share information.

YES

$3,250.00

 100.00%
Orthodontia - Child
NO
Routine Dental Services (Adult)

Refer to plan summary for specific copay/cost-share information.

YES

$5.00

 100.00%

DeltaCare USA Preferred Plan for Families Health Insurance Plan Variant 14948UT0040004-01 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 High On Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1.0
First Tier Utilization 100%
HIOS Product ID 14948UT004
Import Date 2023-08-16 20:01:48
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 14948
Issuer Marketplace Marketing Name DeltaCare USA
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 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 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 High
Multiple In Network Tiers No
National Network No
Network ID UTN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 2024-01-01
Plan Expiration Date 2024-12-31
Plan ID (Standard Component ID with Variant) 14948UT0040004-01
Plan Marketing Name DeltaCare USA Preferred Plan for Families
Plan Type HMO
Plan Variant Marketing Name DeltaCare USA Preferred Plan for Families
QHP/Non QHP On the Exchange
Service Area ID UTS001
Source Name SERFF
Plan ID 14948UT0040004
State Code UT
URL for Enrollment Payment URL

Copay & Coinsurance of DeltaCare USA Preferred Plan for Families Health Insurance Plan, 14948UT0040004

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

Frequently Asked Questions(FAQ) about DeltaCare USA Preferred Plan for Families, 14948UT0040004 Health Insurance Plan, 14948UT0040004

  • Does DeltaCare USA Preferred Plan for Families Health Insurance Plan, 14948UT0040004 support Mail Ordering?

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

    • Does (14948UT0040004) Health Insurance Plan, Variant (14948UT0040004-01) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (14948UT0040004) Health Insurance Plan, Variant (14948UT0040004-01) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

 

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