HDS Classic Dental Plan - 46082HI0020004 Health Insurance Plan
Hawaii Dental Service health insurance plan with the Plan ID 46082HI0020004. The plan is called HDS Classic Dental Plan.
| Health Insurance Plan ID | 46082HI0020004 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Hawaii | ||||||||||||||||||
| Health Insurance Issuer | Hawaii Dental Service | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 46082HI0020004-01 | ||||||||||||||||||
| Provider Network(s) | DELTA-DENTAL-PREMIER | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Sat, 08 Jun 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of HDS Classic Dental Plan Health Insurance Plan, 46082HI0020004-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Exclusions: Composite/white fillings on posterior teeth benefitted as amalgam/silver equivalent. Fillings, root canals, gum surgeries & treatments, oral surgeries; 3 or 12 month wait period applies. |
YES | 70.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Basic Dental Care - Child
Exclusions: Composite/white fillings on posterior teeth benefitted as amalgam/silver equivalent. Fillings, root canals, gum surgeries & treatments, oral surgeries |
YES | 70.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Visit(s) per Year Exam, Cleaning, and/or Fluoride |
YES | No Charge |
No Charge |
| Major Dental Care - Adult
Exclusions: Porcelain crowns on molar teeth benefitted as metallic equivalent; implants Crowns, gold restoration, bridges, and dentures; 12-month wait period applies |
YES | 70.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Major Dental Care - Child
Exclusions: Porcelain crowns on molar teeth benefitted as metallic equivalent; implants Crowns, gold restoration, bridges, and dentures |
YES | 70.00% Coinsurance after deductible |
70.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Exclusions: Optional orthodontia Medically necessary orthodontia |
YES | 50.00% |
50.00% |
| Routine Dental Services (Adult)
Limit: 2.0 Visit(s) per Year Exam, Cleaning, and/or Fluoride |
YES | No Charge |
No Charge |
HDS Classic Dental Plan Health Insurance Plan Variant 46082HI0020004-01 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 | 46082HI002 |
| Import Date | 2024-06-08 20:01:16 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 46082 |
| Issuer Marketplace Marketing Name | Hawaii Dental Service |
| Market Coverage | Individual |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | $850 per group |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | $425 per person |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $425 |
| 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 | $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 | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | Not Applicable |
| 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 | HIN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | For services received outside of the country, member will pay the claim in full at the time of service. Member is responsible to submit the claim to HDS translated into English and U.S. Dollars. HDS will reimburse the member based on a non participating dentist fee schedule. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Service area includes: Hawaii, Guam and Saipan. For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist. The Delta Dentist will submit claim directly to HDS. Member out-of-pocket share will be in accordance to the plan benefits. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 46082HI0020004-01 |
| Plan Level Exclusions | Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply. |
| Plan Marketing Name | HDS Classic Dental Plan |
| Plan Type | PPO |
| Plan Variant Marketing Name | HDS Classic Dental Plan |
| QHP/Non QHP | Both |
| Service Area ID | HIS001 |
| Source Name | SERFF |
| Plan ID | 46082HI0020004 |
| State Code | HI |
| URL for Summary of Benefits & Coverage | URL |
Copay & Coinsurance of HDS Classic Dental Plan Health Insurance Plan, 46082HI0020004
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about HDS Classic Dental Plan, 46082HI0020004 Health Insurance Plan, 46082HI0020004
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Does HDS Classic Dental Plan Health Insurance Plan, 46082HI0020004 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (46082HI0020004) Health Insurance Plan, Variant (46082HI0020004-01) have Out Of Country Coverage?
Does (46082HI0020004) Health Insurance Plan, Variant (46082HI0020004-01) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Thu, 21 Nov 2024 00:44 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