DentaQuest National Insurance Company, Inc. health insurance plan with the Plan ID 34964OH0030001. The plan is called DentaQuest PPO Pediatric High.
Health Insurance Plan ID | 34964OH0030001 | ||||||||||||||||||
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Health Insurance Plan Year | 2025 | ||||||||||||||||||
State | Ohio | ||||||||||||||||||
Health Insurance Issuer | DentaQuest National Insurance Company, Inc. | ||||||||||||||||||
Health Insurance Plan Variant | 34964OH0030001-00 | ||||||||||||||||||
Provider Network(s) | NULL | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Fri, 10 May 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 10 Dec 2024 06:32 GMT |
Benefit | Covered | In Network | Out Of Network |
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Accidental Dental
Limit: 1.0 Treatment(s) per Episode |
YES | No Charge |
No Charge |
Basic Dental Care - Adult
|
NO | ||
Basic Dental Care - Child
Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
Dental Check-Up for Children
Limit: 1.0 Exam(s) per 6 Months Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge |
No Charge |
Major Dental Care - Adult
|
NO | ||
Major Dental Care - Child
Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | 50.00% |
50.00% |
Routine Dental Services (Adult)
|
NO |
Plan Attribute | Value |
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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 Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard High Off Exchange Plan |
Dental Only Plan | Yes |
EHB Apportionment for Pediatric Dental | 1.0 |
First Tier Utilization | 100% |
HIOS Product ID | 34964OH003 |
Import Date | 2024-05-10 20:01:48 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 34964 |
Issuer Marketplace Marketing Name | DentaQuest Insurance Company Inc- OH |
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 | $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 | OHN002 |
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 Effective Date | 2025-01-01 |
Plan Expiration Date | 2025-12-31 |
Plan ID (Standard Component ID with Variant) | 34964OH0030001-00 |
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 | OHS001 |
Source Name | SERFF |
Plan ID | 34964OH0030001 |
State Code | OH |
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 |
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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 Dec 2024 06:32 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