Delta Dental MAC - 28415OR0260001 Health Insurance Plan
Oregon Dental Service, DBA Delta Dental Plan of Oregon health insurance plan with the Plan ID 28415OR0260001. The plan is called Delta Dental MAC.
| Health Insurance Plan ID | 28415OR0260001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Oregon | ||||||||||||||||||
| Health Insurance Issuer | Oregon Dental Service, DBA Delta Dental Plan of Oregon | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 28415OR0260001-00 | ||||||||||||||||||
| Provider Network(s) | ['ORN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Apr 2024 06:19 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 08 Feb 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Apr 2024 06:19 GMT |
Benefits of Delta Dental MAC Health Insurance Plan, 28415OR0260001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Limit: 1200.0 Dollars per Year 6-month exclusion period for age 19 and over if member does not have 12 continuous months of prior dental coverage with no more than a 90-day break in coverage from the end of the old policy to the effective date of the new policy |
YES | 40.00% |
50.00% |
| Basic Dental Care - Child
|
YES | 30.00% |
50.00% |
| Dental Check-Up for Children
Quantitative limit units apply, see EHB benchmark |
YES | No Charge |
20.00% |
| Major Dental Care - Adult
Limit: 1200.0 Dollars per Year 12-month exclusion period for age 19 and over if member does not have 12 continuous months of prior dental coverage with no more than a 90-day break in coverage from the end of the old policy to the effective date of the new policy. |
YES | 50.00% |
50.00% |
| Major Dental Care - Child
Quantitative limit units apply, see EHB benchmark |
YES | 50.00% |
50.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Covered only when necessary to treat cleft palate with or without cleft lip for members under age 19 |
YES | 50.00% |
50.00% |
| Routine Dental Services (Adult)
Limit: 1200.0 Dollars per Year See policy for additional limitations. 1200 annual maximum plan payment limit combined for all routine, basic, and major services. |
YES | No Charge |
20.00% |
Delta Dental MAC Health Insurance Plan Variant 28415OR0260001-00 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 | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Low Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1 |
| First Tier Utilization | 100% |
| HIOS Product ID | 28415OR026 |
| Import Date | 2/8/2023 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | New |
| Issuer ID | 28415 |
| Issuer Marketplace Marketing Name | Delta Dental Plan of Oregon |
| 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 | $0 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $0 |
| 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 | $750 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 | ORN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Providers treated as out of network |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | National network |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 28415OR0260001-00 |
| Plan Marketing Name | Delta Dental MAC |
| Plan Type | PPO |
| Plan Variant Marketing Name | Delta Dental MAC |
| QHP/Non QHP | Both |
| Service Area ID | ORS003 |
| Source Name | SERFF |
| Plan ID | 28415OR0260001 |
| State Code | OR |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Delta Dental MAC Health Insurance Plan, 28415OR0260001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Delta Dental MAC, 28415OR0260001 Health Insurance Plan, 28415OR0260001
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Does Delta Dental MAC Health Insurance Plan, 28415OR0260001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (28415OR0260001) Health Insurance Plan, Variant (28415OR0260001-00) have Out Of Country Coverage?
Does (28415OR0260001) Health Insurance Plan, Variant (28415OR0260001-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 16 Apr 2024 06:19 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