PacificSource Health Plans health insurance plan with the Plan ID 60597ID0420008. The plan is called Kids Dental PPO 20-40-50.
Health Insurance Plan ID | 60597ID0420008 | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Idaho | ||||||||||||||||||
Health Insurance Issuer | PacificSource Health Plans | ||||||||||||||||||
Health Insurance Plan Variant | 60597ID0420008-01 | ||||||||||||||||||
Provider Network(s) | ['IDN003'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 17 Dec 2024 06:12 GMT). |
|
||||||||||||||||||
Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 17 Dec 2024 06:12 GMT |
Plan Attribute | Value |
---|---|
Business Year | 2024 |
Child-Only Offering | Allows Child-Only |
Composite Rating Offered | Yes |
CSR Variation Type | Standard Low On Exchange Plan |
Dental Only Plan | Yes |
First Tier Utilization | 100% |
HIOS Product ID | 60597ID042 |
Import Date | 2/12/2024 |
Guaranteed Rate | Guaranteed Rate |
IsItANewPlan | Existing |
Issuer ID | 60597 |
Market Coverage | SHOP (Small Group) |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family | $400 per person | $800 per group |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $400 |
Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
Medical EHB Deductible, In Network (Tier 1), Family | per person not applicable | per group not applicable |
Medical EHB Deductible, In Network (Tier 1), Individual | Not Applicable |
Medical EHB Deductible, Out of Network, Family | $50 per person | $150 per group |
Medical EHB Deductible, Out of Network, Individual | $50 |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family | per person not applicable | per group 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 person not applicable | per group 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 | IDN003 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Emergency care only |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Non-participating providers |
Plan Effective Date | 1/1/2024 |
Plan Expiration Date | 12/31/2024 |
Plan ID (Standard Component ID with Variant) | 60597ID0420008-01 |
Plan Marketing Name | Kids Dental PPO 20-40-50 |
Plan Type | PPO |
Plan Variant Marketing Name | Kids Dental PPO 20-40-50 |
QHP/Non QHP | Both |
Service Area ID | IDS005 |
Source Name | SERFF |
Plan ID | 60597ID0420008 |
State Code | ID |
Version Number | 1 |
Wellness Program Offered | No |
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, 17 Dec 2024 06:12 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