HMSA Individual Dental PPO Gold - 18350HI0920003 Health Insurance Plan
Hawaii Medical Service Association health insurance plan with the Plan ID 18350HI0920003. The plan is called HMSA Individual Dental PPO Gold.
| Health Insurance Plan ID | 18350HI0920003 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | Hawaii | ||||||||||||||||||
| Health Insurance Issuer | Hawaii Medical Service Association | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 18350HI0920003-00 | ||||||||||||||||||
| Provider Network(s) | ['HIN004'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 29 Nov 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of HMSA Individual Dental PPO Gold Health Insurance Plan, 18350HI0920003-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Fillings -6 month waiting period. See policy for details |
YES | 30.00% |
40.00% |
| Basic Dental Care - Child
Fillings -See policy for details |
YES | 30.00% |
40.00% |
| Dental Check-Up for Children
Cleaning, fluoride, exams, sealants - See policy for details |
YES | No Charge |
20.00% |
| Major Dental Care - Adult
Crowns, Endodontic and Periodontic Services -12 month waiting period. See policy for details |
YES | 50.00% |
70.00% |
| Major Dental Care - Child
Crowns -See policy for details |
YES | 50.00% |
70.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Medically Necessary Only |
YES | 50.00% |
100.00% |
| Routine Dental Services (Adult)
Cleaning, exams - See policy for details |
YES | No Charge |
20.00% |
HMSA Individual Dental PPO Gold Health Insurance Plan Variant 18350HI0920003-00 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 | 2024 |
| 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 | 0.993 |
| First Tier Utilization | 100% |
| HIOS Product ID | 18350HI092 |
| Import Date | 2023-11-29 20:03:17 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 18350 |
| Issuer Marketplace Marketing Name | HMSA |
| 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 | $0 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $0 |
| 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 | Yes |
| Network ID | HIN004 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Out of area service benefits are available as defined in the Policy but members may have a higher cost share |
| Plan Brochure | URL |
| Plan Effective Date | 2024-01-01 |
| Plan Expiration Date | 2024-12-31 |
| Plan ID (Standard Component ID with Variant) | 18350HI0920003-00 |
| Plan Marketing Name | HMSA Individual Dental PPO Gold |
| Plan Type | PPO |
| Plan Variant Marketing Name | HMSA Individual Dental PPO Gold |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | HIS002 |
| Source Name | SERFF |
| Plan ID | 18350HI0920003 |
| State Code | HI |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
Copay & Coinsurance of HMSA Individual Dental PPO Gold Health Insurance Plan, 18350HI0920003
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about HMSA Individual Dental PPO Gold, 18350HI0920003 Health Insurance Plan, 18350HI0920003
-
Does HMSA Individual Dental PPO Gold Health Insurance Plan, 18350HI0920003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (18350HI0920003) Health Insurance Plan, Variant (18350HI0920003-00) have Out Of Country Coverage?
Does (18350HI0920003) Health Insurance Plan, Variant (18350HI0920003-00) 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