Family Basic Dental Plan (Low) - 92388TX0190001 Health Insurance Plan

MetLife health insurance plan with the Plan ID 92388TX0190001. The plan is called Family Basic Dental Plan (Low).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 92388TX0190001
Health Insurance Plan Year 2025
State Texas
Health Insurance Issuer MetLife
Health Insurance Plan Variant 92388TX0190001-00
Provider Network(s) ['TXN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 26 Nov 2024 06:27 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 - 92388TX0190001-00

Last Plan Update Date Wed, 31 Jul 2024 00:00 GMT
Last Import Date Tue, 26 Nov 2024 06:27 GMT

Benefits of Family Basic Dental Plan (Low) Health Insurance Plan, 92388TX0190001-00

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

Limit: 1.0 Treatment(s) per Procedure

YES

50% Coinsurance after deductible

50% Coinsurance after deductible
Basic Dental Care - Child

Limit: 1.0 Treatment(s) per Procedure

YES

50% Coinsurance after deductible

50% Coinsurance after deductible
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

YES

10% Coinsurance after deductible

10% Coinsurance after deductible
Major Dental Care - Adult

Limit: 1.0 Treatment(s) per Procedure

YES

50% Coinsurance after deductible

50% Coinsurance after deductible
Major Dental Care - Child

Limit: 1.0 Treatment(s) per Procedure

YES

50% Coinsurance after deductible

50% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child
YES

50.00%

50.00%
Routine Dental Services (Adult)

Limit: 1.0 Visit(s) per 6 Months

YES

10% Coinsurance after deductible

10% Coinsurance after deductible

Family Basic Dental Plan (Low) Health Insurance Plan Variant 92388TX0190001-00 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 Low Off Exchange Plan
Dental Only Plan Yes
First Tier Utilization 100%
HIOS Product ID 92388TX019
Import Date 2024-07-31 01:01:17
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer Actuarial Value 70.00%
Issuer ID 92388
Issuer Marketplace Marketing Name MetLife
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 $300 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $100 per person
Medical EHB Deductible, In Network (Tier 1), Individual $100
Medical EHB Deductible, Out of Network, Family Per Group $300 per group
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 $850 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $425 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $425
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 Low
Multiple In Network Tiers No
National Network Yes
Network ID TXN001
Out of Country Coverage Yes
Out of Country Coverage Description Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description The PPO plan has an indemnity schedule of benefits for out of service area coverage.
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 92388TX0190001-00
Plan Level Exclusions When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.
Plan Marketing Name Family Basic Dental Plan (Low)
Plan Type PPO
Plan Variant Marketing Name Family Basic Dental Plan (Low)
QHP/Non QHP Off the Exchange
Service Area ID TXS001
Source Name HIOS
Plan ID 92388TX0190001
State Code TX

Copay & Coinsurance of Family Basic Dental Plan (Low) Health Insurance Plan, 92388TX0190001

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

Frequently Asked Questions(FAQ) about Family Basic Dental Plan (Low), 92388TX0190001 Health Insurance Plan, 92388TX0190001

  • Does Family Basic Dental Plan (Low) Health Insurance Plan, 92388TX0190001 support Mail Ordering?

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

  • Does (92388TX0190001) Health Insurance Plan, Variant (92388TX0190001-00) have Out Of Country Coverage?

    Yes. Details: Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.

    Does (92388TX0190001) Health Insurance Plan, Variant (92388TX0190001-00) have Out of Service Area Coverage?

    Yes. Details: The PPO plan has an indemnity schedule of benefits for 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