Utah Preferred Plus Plan (Pediatric Only) - 87169UT0050003 Health Insurance Plan

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
Health Insurance Plan Year 2025
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) PREFERRED
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 Utah 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 - 87169UT0050003-00

Standard On Exchange Plan - 87169UT0050003-01

Last Plan Update Date Tue, 13 Aug 2024 00:00 GMT
Last Import Date Thu, 21 Nov 2024 00:44 GMT

Benefits of Utah Preferred Plus Plan (Pediatric Only) Health Insurance Plan, 87169UT0050003-01

Benefit Covered In Network Out Of Network
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

Utah Preferred Plus Plan (Pediatric Only) Health Insurance Plan Variant 87169UT0050003-01 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 Child-Only
Composite Rating Offered No
CSR Variation Type Standard High On Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1.0
First Tier Utilization 100%
HIOS Product ID 87169UT005
Import Date 2024-08-13 20:01:38
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 $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 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 2025-01-01
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

Copay & Coinsurance of Utah Preferred Plus Plan (Pediatric Only) Health Insurance Plan, 87169UT0050003

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

Frequently Asked Questions(FAQ) about Utah Preferred Plus Plan (Pediatric Only), 87169UT0050003 Health Insurance Plan, 87169UT0050003

  • Does Utah Preferred Plus Plan (Pediatric Only) Health Insurance Plan, 87169UT0050003 support Mail Ordering?

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

    • Does (87169UT0050003) Health Insurance Plan, Variant (87169UT0050003-01) have Out Of Country Coverage?

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

    Does (87169UT0050003) Health Insurance Plan, Variant (87169UT0050003-01) have Out of Service Area Coverage?

    Yes. Details: Same Benefit Level

 

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