Dental Plan 4 with Ortho Rider - Non-Alliance - 80627OH0230016 Health Insurance Plan
Medical Mutual of Ohio health insurance plan with the Plan ID 80627OH0230016. The plan is called Dental Plan 4 with Ortho Rider - Non-Alliance.
| Health Insurance Plan ID | 80627OH0230016 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Ohio | ||||||||||||||||||
| Health Insurance Issuer | Medical Mutual of Ohio | ||||||||||||||||||
| Health Insurance Plan Variant | 80627OH0230016-00 | ||||||||||||||||||
| Provider Network(s) | ['OHN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 26 Nov 2024 06:27 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Tue, 25 Jun 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 26 Nov 2024 06:27 GMT |
Benefits of Dental Plan 4 with Ortho Rider - Non-Alliance Health Insurance Plan, 80627OH0230016-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
|
YES | 20.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
| Basic Dental Care - Child
|
YES | No Charge |
60.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 1.0 Exam(s) per 6 Months |
YES | No Charge |
50.00% Coinsurance after deductible |
| Major Dental Care - Adult
|
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Major Dental Care - Child
|
YES | No Charge |
75.00% Coinsurance after deductible |
| Orthodontia - Adult
|
YES | 40.00% |
50.00% |
| Orthodontia - Child
Medically necessary only. |
YES | No Charge |
75.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
Limit: 1.0 Exam(s) per 6 Months |
YES | No Charge |
20.00% |
Dental Plan 4 with Ortho Rider - Non-Alliance Health Insurance Plan Variant 80627OH0230016-00 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 | 80627OH023 |
| Import Date | 2024-06-25 20:01:27 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 80627 |
| Issuer Marketplace Marketing Name | MedMutual |
| 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 | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | $100 per person |
| Medical EHB Deductible, Out of Network, Individual | $100 |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $0 |
| 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 | OHN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Covered as Non-Network |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 80627OH0230016-00 |
| Plan Marketing Name | Dental Plan 4 with Ortho Rider - Non-Alliance |
| Plan Type | PPO |
| Plan Variant Marketing Name | Dental Plan 4 with Ortho Rider - Non-Alliance |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | OHS001 |
| Source Name | SERFF |
| Plan ID | 80627OH0230016 |
| State Code | OH |
Copay & Coinsurance of Dental Plan 4 with Ortho Rider - Non-Alliance Health Insurance Plan, 80627OH0230016
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Dental Plan 4 with Ortho Rider - Non-Alliance, 80627OH0230016 Health Insurance Plan, 80627OH0230016
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Does Dental Plan 4 with Ortho Rider - Non-Alliance Health Insurance Plan, 80627OH0230016 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (80627OH0230016) Health Insurance Plan, Variant (80627OH0230016-00) have Out Of Country Coverage?
Does (80627OH0230016) Health Insurance Plan, Variant (80627OH0230016-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 26 Nov 2024 06:27 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