Dental Advantage Core - 10091OR0730003 Health Insurance Plan

PacificSource Health Plans health insurance plan with the Plan ID 10091OR0730003. The plan is called Dental Advantage Core.

Health Insurance Plan ID 10091OR0730003
Health Insurance Plan Year 2023
State Oregon
Health Insurance Issuer PacificSource Health Plans
Health Insurance Plan Variant 10091OR0730003-01
Provider Network(s) ['ORN003']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Oregon 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 On Exchange Plan - 10091OR0730003-01

Last Plan Update Date Mon, 23 Jan 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Dental Advantage Core Health Insurance Plan Variant 10091OR0730003-01 Attributes

Plan Attribute Value
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered Yes
CSR Variation Type Standard High On Exchange Plan
Dental Only Plan Yes
First Tier Utilization 100%
HIOS Product ID 10091OR073
Import Date 1/23/2023
Guaranteed Rate Guaranteed Rate
IsItANewPlan Existing
Issuer ID 10091
Market Coverage SHOP (Small Group)
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family per person not applicable | per group 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 person not applicable | per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Medical EHB Deductible, In Network (Tier 1), Family per person not applicable | per group not applicable
Medical EHB Deductible, In Network (Tier 1), Individual Not Applicable
Medical EHB Deductible, Out of Network, Family $50 per person | $150 per group
Medical EHB Deductible, Out of Network, Individual $50
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family $375 per person | $750 per group
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 person not applicable | per group 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 ORN003
Out of Country Coverage Yes
Out of Country Coverage Description Emergency care only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Non-participating providers
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 10091OR0730003-01
Plan Marketing Name Dental Advantage Core
Plan Type PPO
Plan Variant Marketing Name Dental Advantage Core
QHP/Non QHP Both
Service Area ID ORS005
Source Name SERFF
Plan ID 10091OR0730003
State Code OR
Version Number 1
Wellness Program Offered No

Copay & Coinsurance of Dental Advantage Core Health Insurance Plan, 10091OR0730003

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

Frequently Asked Questions(FAQ) about Dental Advantage Core, 10091OR0730003 Health Insurance Plan, 10091OR0730003

  • Does Dental Advantage Core Health Insurance Plan, 10091OR0730003 support Mail Ordering?

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

  • Does (10091OR0730003) Health Insurance Plan, Variant (10091OR0730003-01) have Out Of Country Coverage?

    Yes. Details: Emergency care only

    Does (10091OR0730003) Health Insurance Plan, Variant (10091OR0730003-01) have Out of Service Area Coverage?

    Yes. Details: Non-participating providers

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 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