Guardian Basics for Families and Individuals - 55440NC0240004 Health Insurance Plan
The Guardian Life Insurance Company health insurance plan with the Plan ID 55440NC0240004. The plan is called Guardian Basics for Families and Individuals.
| Health Insurance Plan ID | 55440NC0240004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | North Carolina | ||||||||||||||||||
| Health Insurance Issuer | The Guardian Life Insurance Company | ||||||||||||||||||
| Health Insurance Plan Variant | 55440NC0240004-01 | ||||||||||||||||||
| Provider Network(s) | CS--STRATOSE-QUALIDENT-DENTAL-NETWORK CS--STRATOSE-TDA-PPO CR--PREMIER-MN-FL-DENTAL-NETWORK-EXCEL CD--DENTALGUARD-CONNECT---ADMIN-PROVIDERS CS--STRATOSE-MDENT CD--PREMIER-ACCESS-PCN CJ--CAREINGTON-PLATINUM CM--METLIFE CS--STRATOSE-FSB-MAVEREST DD--DENTALGUARD-ELITE CS--AETNA CJ--CAREINGTON-CARESERIES CR--PREMIER-MN-FL-DENTAL-NETWORK-CLASSIC CX--CONNECTION-DENTAL--PPO-USA CA--PREMIER-ACCESS-PPO CS--STRATOSE-PCDPRI CW--DENTEMAX CS--STRATOSE-PDPPRI | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Sat, 14 Sep 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 24 Dec 2024 06:21 GMT |
Benefits of Guardian Basics for Families and Individuals Health Insurance Plan, 55440NC0240004-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
An annual deductible and maximum apply to adult services. A 6-month waiting period applies to Basic Dental Care for adults. |
YES | 40.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
| Basic Dental Care - Child
|
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Benefit Period |
YES | No Charge after deductible |
10.00% Coinsurance after deductible |
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
YES | 50.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
YES | 50.00% |
70.00% |
| Routine Dental Services (Adult)
An annual deductible and maximum apply to adult services. |
YES | No Charge after deductible |
No Charge after deductible |
Guardian Basics for Families and Individuals Health Insurance Plan Variant 55440NC0240004-01 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 | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low On Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1.0 |
| First Tier Utilization | 100% |
| HIOS Product ID | 55440NC024 |
| Import Date | 2024-09-14 01:01:31 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | New |
| Issuer ID | 55440 |
| Issuer Marketplace Marketing Name | Guardian |
| 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 | 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 | $50 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $50 |
| 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 | $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 | NCN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage is provided outside of the Service Area. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 55440NC0240004-01 |
| Plan Marketing Name | Guardian Basics for Families and Individuals |
| Plan Type | PPO |
| Plan Variant Marketing Name | Guardian Basics for Families and Individuals |
| QHP/Non QHP | Both |
| Service Area ID | NCS001 |
| Source Name | HIOS |
| Plan ID | 55440NC0240004 |
| State Code | NC |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
Copay & Coinsurance of Guardian Basics for Families and Individuals Health Insurance Plan, 55440NC0240004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Guardian Basics for Families and Individuals, 55440NC0240004 Health Insurance Plan, 55440NC0240004
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Does Guardian Basics for Families and Individuals Health Insurance Plan, 55440NC0240004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (55440NC0240004) Health Insurance Plan, Variant (55440NC0240004-01) have Out Of Country Coverage?
Does (55440NC0240004) Health Insurance Plan, Variant (55440NC0240004-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 24 Dec 2024 06:21 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