Dental Care Plus, Inc. health insurance plan with the Plan ID 49941WI0040003. The plan is called DentaTrust-PPO Family High Option.
Health Insurance Plan ID | 49941WI0040003 | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Wisconsin | ||||||||||||||||||
Health Insurance Issuer | Dental Care Plus, Inc. | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 49941WI0040003-00 | ||||||||||||||||||
Provider Network(s) | ['WIN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 22 Oct 2024 06:47 GMT). |
|
||||||||||||||||||
Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Sat, 14 May 2022 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 22 Oct 2024 06:47 GMT |
Benefit | Covered | In Network | Out Of Network |
---|---|---|---|
Accidental Dental
|
NO | ||
Basic Dental Care - Adult
Subject to a 6 month waiting period. See plan brochure for plan details and limitations and exclusions. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
Basic Dental Care - Child
See plan brochure for plan details and limitations and exclusions. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year See plan brochure for plan details and limitations and exclusions. |
YES | No Charge |
No Charge |
Major Dental Care - Adult
Subject to a 12 month waiting period. See plan brochure for plan details and limitations and exclusions. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Major Dental Care - Child
See plan brochure for plan details and limitations and exclusions. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
Exclusions: Non-medically necessary orthodontic treatment will not be covered by the plan. See plan brochure for plan details and limitations and exclusions. |
YES | 50.00% |
50.00% |
Routine Dental Services (Adult)
Limit: 2.0 Visit(s) per Year See plan brochure for plan details and limitations and exclusions. |
YES | No Charge |
No Charge |
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 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 | 1 |
First Tier Utilization | 100% |
HIOS Product ID | 49941WI004 |
Import Date | 5/14/2022 1:00 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 49941 |
Issuer Marketplace Marketing Name | DentaTrust/DentaSpan |
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 | WIN001 |
Out of Country Coverage | No |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Out-of-Network coverage is available for covered services obtained from non-participating dentists. See the schedule of benefits for out-of-network coverage levels. |
Plan Brochure | URL |
Plan Effective Date | 1/1/2023 |
Plan Expiration Date | 12/31/2023 |
Plan ID (Standard Component ID with Variant) | 49941WI0040003-00 |
Plan Level Exclusions | Please refer to the exclusions listed in the Plan Brochure for specific plan level exclusions. |
Plan Marketing Name | DentaTrust-PPO Family High Option |
Plan Type | PPO |
Plan Variant Marketing Name | DentaTrust-PPO Family High Option |
QHP/Non QHP | Both |
Service Area ID | WIS001 |
Source Name | HIOS |
Plan ID | 49941WI0040003 |
State Code | WI |
URL for Enrollment Payment | URL |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
---|
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, 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