DentaQuest PPO Pediatric High - 58609TX0010001 Health Insurance Plan

DentaQuest USA Insurance Company, Inc. health insurance plan with the Plan ID 58609TX0010001. The plan is called DentaQuest PPO Pediatric High.

Health Insurance Plan ID 58609TX0010001
Health Insurance Plan Year 2023
State Texas
Health Insurance Issuer DentaQuest USA Insurance Company, Inc.
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 58609TX0010001-01
Provider Network(s) ['TXN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 22 Oct 2024 06:47 GMT).

Providers Texas 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 - 58609TX0010001-00

Standard On Exchange Plan - 58609TX0010001-01

Last Plan Update Date Tue, 14 Jun 2022 00:00 GMT
Last Import Date Tue, 22 Oct 2024 06:47 GMT

Benefits of DentaQuest PPO Pediatric High Health Insurance Plan, 58609TX0010001-01

Benefit Covered In Network Out Of Network
Accidental Dental

Limit: 1.0 Treatment(s) per Episode

Frequency of service varies based upon procedure, see summary of benefits for additional information

YES

No Charge

 No Charge
Basic Dental Care - Adult
NO
Basic Dental Care - Child
YES

20.00% Coinsurance after deductible

 20.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

YES

No Charge

 No Charge
Major Dental Care - Adult
NO
Major Dental Care - Child

frequency of service varies based upon procedure, see summary of benefits for additional information

YES

50.00% Coinsurance after deductible

 50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child
YES

50.00%

 50.00%
Routine Dental Services (Adult)
NO

DentaQuest PPO Pediatric High Health Insurance Plan Variant 58609TX0010001-01 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 2023
Child-Only Offering Allows Child-Only
Composite Rating Offered No
CSR Variation Type Standard High On Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1
First Tier Utilization 100%
HIOS Product ID 58609TX001
Import Date 6/14/2022 1:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 58609
Issuer Marketplace Marketing Name DentaQuest USA Insurance Company, Inc.
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 $150 per group
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 $700 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $350 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $350
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 TXN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Only. In excess of 50 miles from nearest provider.
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 58609TX0010001-01
Plan Marketing Name DentaQuest PPO Pediatric High
Plan Type PPO
Plan Variant Marketing Name DentaQuest PPO Pediatric High
QHP/Non QHP Both
Service Area ID TXS001
Source Name HIOS
Plan ID 58609TX0010001
State Code TX
URL for Enrollment Payment URL

Copay & Coinsurance of DentaQuest PPO Pediatric High Health Insurance Plan, 58609TX0010001

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

Frequently Asked Questions(FAQ) about DentaQuest PPO Pediatric High, 58609TX0010001 Health Insurance Plan, 58609TX0010001

  • Does DentaQuest PPO Pediatric High Health Insurance Plan, 58609TX0010001 support Mail Ordering?

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

    • Does (58609TX0010001) Health Insurance Plan, Variant (58609TX0010001-01) have Out Of Country Coverage?

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

    Does (58609TX0010001) Health Insurance Plan, Variant (58609TX0010001-01) have Out of Service Area Coverage?

    Yes. Details: Emergency Only. In excess of 50 miles from nearest provider.

 

Disclaimer: This is based on the import(Date: Tue, 22 Oct 2024 06:47 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