Superior Dental Care, Inc health insurance plan with the Plan ID 30042OH0020001. The plan is called SDC-Kids Plan Low.
Health Insurance Plan ID | 30042OH0020001 | ||||||||||||||||||
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Health Insurance Plan Year | 2024 | ||||||||||||||||||
State | Ohio | ||||||||||||||||||
Health Insurance Issuer | Superior Dental Care, Inc | ||||||||||||||||||
Health Insurance Plan Variant | 30042OH0020001-00 | ||||||||||||||||||
Provider Network(s) | ['OHN001'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 20 Aug 2024 06:14 GMT). |
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Available Variants of the Health Plan | |||||||||||||||||||
Last Plan Update Date | Thu, 10 Aug 2023 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 20 Aug 2024 06:14 GMT |
Benefit | Covered | In Network | Out Of Network |
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Accidental Dental
|
NO | ||
Basic Dental Care - Adult
|
NO | ||
Basic Dental Care - Child
Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 30.00% Coinsurance after deductible |
No Charge, 50.00% Coinsurance after deductible |
Dental Check-Up for Children
Limit: 1.0 Exam(s) per 6 Months Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 10.00% Coinsurance after deductible |
No Charge, 30.00% Coinsurance after deductible |
Major Dental Care - Adult
|
NO | ||
Major Dental Care - Child
Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 50.00% Coinsurance after deductible |
No Charge, 70.00% Coinsurance after deductible |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
Coverage includes benefits specified in the FEDVIP MetLife Federal Dental - High Option Plan. |
YES | No Charge, 50.00% |
No Charge, 50.00% |
Routine Dental Services (Adult)
|
NO |
Plan Attribute | Value |
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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 Off Exchange Plan |
Dental Only Plan | Yes |
First Tier Utilization | 100% |
HIOS Product ID | 30042OH002 |
Import Date | 2023-08-10 20:01:43 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 30042 |
Issuer Marketplace Marketing Name | Superior Dental Care, Inc. |
Market Coverage | SHOP (Small Group) |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | $750 per group |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | $375 per person |
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | $375 |
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 | $225 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $225 |
Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
Medical EHB Deductible, In Network (Tier 1), Family Per Person | $75 per person |
Medical EHB Deductible, In Network (Tier 1), Individual | $75 |
Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
Medical EHB Deductible, Out of Network, Family Per Person | $150 per person |
Medical EHB Deductible, Out of Network, Individual | $150 |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | $750 per group |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $375 per person |
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $375 |
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 | OHN001 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Matches in County Coverage |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Matches in County Coverage |
Plan Effective Date | 2024-01-01 |
Plan ID (Standard Component ID with Variant) | 30042OH0020001-00 |
Plan Marketing Name | SDC-Kids Plan Low |
Plan Type | PPO |
Plan Variant Marketing Name | SDC-Kids Plan Low |
QHP/Non QHP | Off the Exchange |
Service Area ID | OHS001 |
Source Name | SERFF |
Plan ID | 30042OH0020001 |
State Code | OH |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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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, 20 Aug 2024 06:14 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