SmartSmile - EC - 25486OR0020001 Health Insurance Plan
Dental Health Services, Inc. health insurance plan with the Plan ID 25486OR0020001. The plan is called SmartSmile - EC.
| Health Insurance Plan ID | 25486OR0020001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | Dental Health Services, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 25486OR0020001-01 | ||||||||||||||||||
| Provider Network(s) | SMARTSMILE-OR | ||||||||||||||||||
| 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 | Wed, 22 May 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Thu, 21 Nov 2024 00:44 GMT |
Benefits of SmartSmile - EC Health Insurance Plan, 25486OR0020001-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Exclusions: See Policy for Detailed Exclusions |
YES | $40.00, No Charge |
100.00% |
| Basic Dental Care - Child
Exclusions: See Policy for Detailed Exclusions |
YES | $47.00, No Charge |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Procedure(s) per 6 Months Exclusions: See Policy for Detailed Exclusions |
YES | $20.00, No Charge |
100.00% |
| Major Dental Care - Adult
Exclusions: See Policy for Detailed Exclusions |
YES | $675.00, No Charge |
100.00% |
| Major Dental Care - Child
Exclusions: See Policy for Detailed Exclusions |
YES | $350.00, No Charge |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Exclusions: See Policy for Detailed Exclusions |
YES | $350.00, No Charge |
100.00% |
| Routine Dental Services (Adult)
Limit: 1.0 Procedure(s) per 6 Months Exclusions: See Policy for Detailed Exclusions |
YES | $7.00, No Charge |
100.00% |
SmartSmile - EC Health Insurance Plan Variant 25486OR0020001-01 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 | 0.93 |
| First Tier Utilization | 100% |
| HIOS Product ID | 25486OR002 |
| Import Date | 2024-05-22 20:01:49 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 25486 |
| Issuer Marketplace Marketing Name | Dental Health Services |
| 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 | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| 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 | $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 | No |
| Network ID | ORN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency coverage only- for the relief of pain, swelling, and bleeding. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency coverage only- for the relief of pain, swelling, and bleeding. |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 25486OR0020001-01 |
| Plan Marketing Name | SmartSmile - EC |
| Plan Type | EPO |
| Plan Variant Marketing Name | SmartSmile - EC |
| QHP/Non QHP | Both |
| Service Area ID | ORS001 |
| Source Name | SERFF |
| Plan ID | 25486OR0020001 |
| State Code | OR |
Copay & Coinsurance of SmartSmile - EC Health Insurance Plan, 25486OR0020001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about SmartSmile - EC, 25486OR0020001 Health Insurance Plan, 25486OR0020001
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Does SmartSmile - EC Health Insurance Plan, 25486OR0020001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (25486OR0020001) Health Insurance Plan, Variant (25486OR0020001-01) have Out Of Country Coverage?
Does (25486OR0020001) Health Insurance Plan, Variant (25486OR0020001-01) 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