Unum MI EHB Plan 2a - 53678MI0080001 Health Insurance Plan

AlwaysCare Benefits, Inc. health insurance plan with the Plan ID 53678MI0080001. The plan is called Unum MI EHB Plan 2a.

Health Insurance Plan ID

53678MI0080001

Health Insurance Plan Year

2025

State

Michigan

Health Insurance Issuer

AlwaysCare Benefits, Inc.

Health Insurance Plan Variant

53678MI0080001-00

Provider Network(s)

['MIN001']

In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Thu, 21 Nov 2024 00:44 GMT).

Providers	Michigan	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 Off Exchange Plan - 53678MI0080001-00

Last Plan Update Date

Sat, 10 Aug 2024 00:00 GMT

Last Import Date

Thu, 21 Nov 2024 00:44 GMT

Benefits of Unum MI EHB Plan 2a Health Insurance Plan, 53678MI0080001-00

Benefit	Covered	In Network	Out Of Network
Accidental Dental Limit: 1500.0 Dollars per Benefit Period	YES	0.00%	0.00%
Basic Dental Care - Adult Limit: 1500.0 Dollars per Benefit Period	YES	10.00% Coinsurance after deductible	10.00% Coinsurance after deductible
Basic Dental Care - Child MIChild, Pages 8-9	YES	10.00% Coinsurance after deductible	10.00% Coinsurance after deductible
Dental Check-Up for Children Limit: 2.0 Visit(s) per Year MIChild, Pages 8-9	YES	0.00%	0.00%
Major Dental Care - Adult Limit: 1500.0 Dollars per Benefit Period	YES	40.00% Coinsurance after deductible	40.00% Coinsurance after deductible
Major Dental Care - Child MIChild, Pages 8-9	YES	40.00% Coinsurance after deductible	40.00% Coinsurance after deductible
Orthodontia - Adult	NO
Orthodontia - Child	NO
Routine Dental Services (Adult) Limit: 1500.0 Dollars per Benefit Period	YES	0.00%	0.00%

Unum MI EHB Plan 2a Health Insurance Plan Variant 53678MI0080001-00 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	2025
Child-Only Offering	Allows Adult and Child-Only
Composite Rating Offered	No
CSR Variation Type	Standard High Off Exchange Plan
Dental Only Plan	Yes
First Tier Utilization	100%
HIOS Product ID	53678MI008
Import Date	2024-08-10 20:01:55
Inpatient Copayment Maximum Days	0
Guaranteed Rate	Guaranteed Rate
New/Existing Plan	Existing
Issuer ID	53678
Issuer Marketplace Marketing Name	AlwaysCare Benefits, Inc.
Market Coverage	SHOP (Small Group)
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	$150 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person	$50 per person
Medical EHB Deductible, In Network (Tier 1), Individual	$50
Medical EHB Deductible, Out of Network, Family Per Group	$150 per group
Medical EHB Deductible, Out of Network, Family Per Person	$50 per person
Medical EHB Deductible, Out of Network, Individual	$50
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group	$850 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person	$425 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual	$425
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	MIN001
Out of Country Coverage	Yes
Out of Country Coverage Description	Any Claim submitted for procedures performed outside the U.S.A. must: 1. be for a Covered Procedure, as defined; 2. be supplied in English; 3. use American Dental Association codes; and 4. be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured's zip code.
Out of Service Area Coverage	Yes
Out of Service Area Coverage Description	Any Claim submitted for procedures performed outside the service area must: 1. be for a Covered Procedure, as defined; 2. be supplied in English; 3. use American Dental Association codes; and 4. be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured's zip code.
Plan Effective Date	2025-01-01
Plan Expiration Date	2025-12-31
Plan ID (Standard Component ID with Variant)	53678MI0080001-00
Plan Marketing Name	Unum MI EHB Plan 2a
Plan Type	PPO
Plan Variant Marketing Name	Unum MI EHB Plan 2a
QHP/Non QHP	Off the Exchange
Service Area ID	MIS001
Source Name	SERFF
Plan ID	53678MI0080001
State Code	MI

Copay & Coinsurance of Unum MI EHB Plan 2a Health Insurance Plan, 53678MI0080001

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

Frequently Asked Questions(FAQ) about Unum MI EHB Plan 2a, 53678MI0080001 Health Insurance Plan, 53678MI0080001

Does Unum MI EHB Plan 2a Health Insurance Plan, 53678MI0080001 support Mail Ordering?

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

Does (53678MI0080001) Health Insurance Plan, Variant (53678MI0080001-00) have Out Of Country Coverage?

Yes. Details: Any Claim submitted for procedures performed outside the U.S.A. must: 1. be for a Covered Procedure, as defined; 2. be supplied in English; 3. use American Dental Association codes; and 4. be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured's zip code.

Does (53678MI0080001) Health Insurance Plan, Variant (53678MI0080001-00) have Out of Service Area Coverage?

Yes. Details: Any Claim submitted for procedures performed outside the service area must: 1. be for a Covered Procedure, as defined; 2. be supplied in English; 3. use American Dental Association codes; and 4. be in U.S. Dollar currency. Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured's zip code.

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