Dental Gold Plus Vision - 75293AR1230004 Health Insurance Plan

USAble Mutual Insurance Company health insurance plan with the Plan ID 75293AR1230004. The plan is called Dental Gold Plus Vision.

Health Insurance Plan ID 75293AR1230004
Health Insurance Plan Year 2024
State Arkansas
Health Insurance Issuer USAble Mutual Insurance Company
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 75293AR1230004-00
Provider Network(s) TRUE-BLUE-PPO PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT).

Providers Arkansas 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 Off Exchange Plan - 75293AR1230004-00

Standard On Exchange Plan - 75293AR1230004-01

Last Plan Update Date Mon, 11 Sep 2023 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Benefits of Dental Gold Plus Vision Health Insurance Plan, 75293AR1230004-00

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

Quantitative limit units apply, see EHB benchmark

YES

20.00% Coinsurance after deductible

 40.00% Coinsurance after deductible
Basic Dental Care - Child
YES

20.00% Coinsurance after deductible

 40.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per 6 Months

Quantitative limit units apply, see EHB benchmark

YES

No Charge after deductible

 25.00% Coinsurance after deductible
Major Dental Care - Adult

Quantitative limit units apply, see EHB benchmark

YES

50.00% Coinsurance after deductible

 70.00% Coinsurance after deductible
Major Dental Care - Child
YES

50.00% Coinsurance after deductible

 70.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child
NO
Routine Dental Services (Adult)
YES

No Charge after deductible

 25.00% Coinsurance after deductible

Dental Gold Plus Vision Health Insurance Plan Variant 75293AR1230004-00 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 2024
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 0.828
First Tier Utilization 100%
HIOS Product ID 75293AR123
Import Date 2023-09-11 20:01:51
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 75293
Issuer Marketplace Marketing Name Arkansas Blue Cross and Blue Shield
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 $35 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $35
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 per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual Not Applicable
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 ARN003
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Benefit reduction for dental care
Plan Brochure URL
Plan Effective Date 2024-01-01
Plan Expiration Date 2024-12-31
Plan ID (Standard Component ID with Variant) 75293AR1230004-00
Plan Marketing Name Dental Gold Plus Vision
Plan Type PPO
Plan Variant Marketing Name Dental Gold Plus Vision
QHP/Non QHP Both
Service Area ID ARS002
Source Name SERFF
Plan ID 75293AR1230004
State Code AR

Copay & Coinsurance of Dental Gold Plus Vision Health Insurance Plan, 75293AR1230004

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

Frequently Asked Questions(FAQ) about Dental Gold Plus Vision, 75293AR1230004 Health Insurance Plan, 75293AR1230004

  • Does Dental Gold Plus Vision Health Insurance Plan, 75293AR1230004 support Mail Ordering?

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

    • Does (75293AR1230004) Health Insurance Plan, Variant (75293AR1230004-00) have Out Of Country Coverage?

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

    Does (75293AR1230004) Health Insurance Plan, Variant (75293AR1230004-00) have Out of Service Area Coverage?

    Yes. Details: Benefit reduction for dental care

 

Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 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