Low PPO Dental Plan (Pediatric Only) - 28419LA0050002 Health Insurance Plan

Renaissance Life & Health Insurance Company of America health insurance plan with the Plan ID 28419LA0050002. The plan is called Low PPO Dental Plan (Pediatric Only).

Health Insurance Plan ID 28419LA0050002
Health Insurance Plan Year 2024
State Louisiana
Health Insurance Issuer Renaissance Life & Health Insurance Company of America
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 28419LA0050002-01
Provider Network(s) PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 GMT).

Providers Louisiana 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 On Exchange Plan - 28419LA0050002-01

Last Plan Update Date Thu, 08 Jun 2023 00:00 GMT
Last Import Date Tue, 24 Dec 2024 06:21 GMT

Benefits of Low PPO Dental Plan (Pediatric Only) Health Insurance Plan, 28419LA0050002-01

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

Exclusions: See Plan Brochure.

YES

40.00% Coinsurance after deductible

 40.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Benefit Period

Exclusions: See Plan Brochure. X-Rays may be subject to deductible.

YES

20.00%

 20.00%
Major Dental Care - Adult
NO
Major Dental Care - Child

Exclusions: See Plan Brochure.

YES

50.00% Coinsurance after deductible

 50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child

Exclusions: Limited to medically necessary. See Plan Brochure.

YES

50.00%

 50.00%
Routine Dental Services (Adult)
NO

Low PPO Dental Plan (Pediatric Only) Health Insurance Plan Variant 28419LA0050002-01 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 2024
Child-Only Offering Allows 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 28419LA005
Import Date 2023-06-08 01:01:41
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 28419
Issuer Marketplace Marketing Name Renaissance Dental
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 $150 per group
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 $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 Low
Multiple In Network Tiers No
National Network Yes
Network ID LAN001
Out of Country Coverage Yes
Out of Country Coverage Description Benefits paid at the Out of Network Level
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Same Benefit Level
Plan Brochure URL
Plan Effective Date 2024-01-01
Plan ID (Standard Component ID with Variant) 28419LA0050002-01
Plan Marketing Name Low PPO Dental Plan (Pediatric Only)
Plan Type PPO
Plan Variant Marketing Name Low PPO Dental Plan (Pediatric Only)
QHP/Non QHP On the Exchange
Service Area ID LAS001
Source Name HIOS
Plan ID 28419LA0050002
State Code LA
URL for Enrollment Payment URL

Copay & Coinsurance of Low PPO Dental Plan (Pediatric Only) Health Insurance Plan, 28419LA0050002

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

Frequently Asked Questions(FAQ) about Low PPO Dental Plan (Pediatric Only), 28419LA0050002 Health Insurance Plan, 28419LA0050002

  • Does Low PPO Dental Plan (Pediatric Only) Health Insurance Plan, 28419LA0050002 support Mail Ordering?

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

    • Does (28419LA0050002) Health Insurance Plan, Variant (28419LA0050002-01) have Out Of Country Coverage?

    Yes. Details: Benefits paid at the Out of Network Level

    Does (28419LA0050002) Health Insurance Plan, Variant (28419LA0050002-01) have Out of Service Area Coverage?

    Yes. Details: Same Benefit Level

 

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