Dentegra Dental PPO Family Basic Plan - 97762VA0010007 Health Insurance Plan

Dentegra Insurance Company health insurance plan with the Plan ID 97762VA0010007. The plan is called Dentegra Dental PPO Family Basic Plan.

Health Insurance Plan ID 97762VA0010007
Health Insurance Plan Year 2023
State Virginia
Health Insurance Issuer Dentegra Insurance Company
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 97762VA0010007-01
Provider Network(s) ['VAN001']
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 Virginia 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 - 97762VA0010007-01

Last Plan Update Date Mon, 15 Aug 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Dentegra Dental PPO Family Basic Plan Health Insurance Plan, 97762VA0010007-01

Benefit Covered In Network Out Of Network
Accidental Dental
YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Basic Dental Care - Adult

Adult enrollees have a $1,000 annual maximum and a $50 individual/$150 family deductible. A 6 month waiting period applies for Basic services.

YES

50.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Basic Dental Care - Child

Benefit limitations may apply to individual services.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

Includes coverage for D1110, D1120, D1206, and D1208.

YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Major Dental Care - Adult
NO
Major Dental Care - Child

Benefit limitations may apply to individual services.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child

Limit: 1.0 Treatment(s) per Lifetime

Limit applies to one comprehensive orthodontic treatment of the adolescent dentition.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Routine Dental Services (Adult)

Limit: 2.0 Visit(s) per Year

2 visit(s) per Calendar Year. Adult enrollees have a $1,000 annual maximum and a $50 individual/$150 family deductible.

YES

0.00% Coinsurance after deductible

10.00% Coinsurance after deductible

Dentegra Dental PPO Family Basic Plan Health Insurance Plan Variant 97762VA0010007-01 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 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Low On Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1
First Tier Utilization 100%
HIOS Product ID 97762VA001
Import Date 8/15/2022 20:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 97762
Issuer Marketplace Marketing Name Dentegra Insurance Company
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 per group not applicable
Medical EHB Deductible, Combined In/Out of Network, Family Per Person $60 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $60
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 Low
Multiple In Network Tiers No
National Network Yes
Network ID VAN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Nationwide Network
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 97762VA0010007-01
Plan Marketing Name Dentegra Dental PPO Family Basic Plan
Plan Type PPO
Plan Variant Marketing Name Dentegra Dental PPO Family Basic Plan
QHP/Non QHP On the Exchange
Service Area ID VAS001
Source Name SERFF
Plan ID 97762VA0010007
State Code VA
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of Dentegra Dental PPO Family Basic Plan Health Insurance Plan, 97762VA0010007

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

Frequently Asked Questions(FAQ) about Dentegra Dental PPO Family Basic Plan, 97762VA0010007 Health Insurance Plan, 97762VA0010007

  • Does Dentegra Dental PPO Family Basic Plan Health Insurance Plan, 97762VA0010007 support Mail Ordering?

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

  • Does (97762VA0010007) Health Insurance Plan, Variant (97762VA0010007-01) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (97762VA0010007) Health Insurance Plan, Variant (97762VA0010007-01) have Out of Service Area Coverage?

    Yes. Details: Nationwide Network

 

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