Renaissance Life & Health Insurance Company of America health insurance plan with the Plan ID 87169UT0050003. The plan is called Utah Preferred Plus Plan (Pediatric Only).
Health Insurance Plan ID | 87169UT0050003 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Utah | ||||||||||||||||||
Health Insurance Issuer | Renaissance Life & Health Insurance Company of America | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 87169UT0050003-01 | ||||||||||||||||||
Provider Network(s) | ['UTN001'] | ||||||||||||||||||
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 | Wed, 17 Aug 2022 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
|
NO | ||
Dental Check-Up for Children
Limit: 2.0 Procedure(s) per Benefit Period Exclusions: See Plan Brochure. Routine cleaning, exams, x-rays and fluoride. Sealants once every five years. |
YES | 0.00% Coinsurance after deductible |
0.00% Coinsurance after deductible |
Major Dental Care - Adult
|
NO | ||
Major Dental Care - Child
|
NO | ||
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
|
NO | ||
Routine Dental Services (Adult)
|
NO |
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 | 2023 |
Child-Only Offering | Allows Child-Only |
Composite Rating Offered | No |
CSR Variation Type | Standard High On Exchange Plan |
Dental Only Plan | Yes |
EHB Apportionment for Pediatric Dental | 1 |
First Tier Utilization | 100% |
HIOS Product ID | 87169UT005 |
Import Date | 8/17/2022 20:01 |
Inpatient Copayment Maximum Days | 0 |
Guaranteed Rate | Guaranteed Rate |
New/Existing Plan | Existing |
Issuer ID | 87169 |
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 | $75 per group |
Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $25 per person |
Medical EHB Deductible, Combined In/Out of Network, Individual | $25 |
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 | High |
Multiple In Network Tiers | No |
National Network | Yes |
Network ID | UTN001 |
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 | 1/1/2023 |
Plan ID (Standard Component ID with Variant) | 87169UT0050003-01 |
Plan Marketing Name | Utah Preferred Plus Plan (Pediatric Only) |
Plan Type | PPO |
Plan Variant Marketing Name | Utah Preferred Plus Plan (Pediatric Only) |
QHP/Non QHP | Both |
Service Area ID | UTS001 |
Source Name | SERFF |
Plan ID | 87169UT0050003 |
State Code | UT |
URL for Enrollment Payment | URL |
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