EssentialSmile 311 - 34095AZ0010001 Health Insurance Plan
Solstice Healthplans of Arizona, Inc. health insurance plan with the Plan ID 34095AZ0010001. The plan is called EssentialSmile 311.
| Health Insurance Plan ID | 34095AZ0010001 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Arizona | ||||||||||||||||||
| Health Insurance Issuer | Solstice Healthplans of Arizona, Inc. | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 34095AZ0010001-00 | ||||||||||||||||||
| Provider Network(s) | ['AZN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 23 Apr 2024 07:07 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Fri, 18 Nov 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 23 Apr 2024 07:07 GMT |
Benefits of EssentialSmile 311 Health Insurance Plan, 34095AZ0010001-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Includes Coverage for White Fillings, Deep Cleanings, Extractions and Other Minor Restorative Procedures |
YES | $56.00 |
100.00% |
| Basic Dental Care - Child
|
YES | No Charge after deductible |
100.00% |
| Dental Check-Up for Children
|
YES | No Charge after deductible |
100.00% |
| Major Dental Care - Adult
Includes Coverage for Crowns, Bridges, Dentures, Root Canals and Surgical Implants |
YES | $260.00 |
100.00% |
| Major Dental Care - Child
|
YES | $320.00 Copay after deductible |
100.00% |
| Orthodontia - Adult
Includes Coverage for Cosmetic Orthodontia and Related Procedures |
YES | $3,700.00 |
100.00% |
| Orthodontia - Child
|
YES | $320.00 Copay after deductible |
100.00% |
| Routine Dental Services (Adult)
Includes Coverage For Routine Cleanings, Exams, Fluoride, Sealants and X-Rays |
YES | $10.00 |
100.00% |
EssentialSmile 311 Health Insurance Plan Variant 34095AZ0010001-00 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 High Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 1 |
| First Tier Utilization | 100% |
| HIOS Product ID | 34095AZ001 |
| Import Date | 11/18/2022 1:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 34095 |
| Issuer Marketplace Marketing Name | Solstice Healthplans of Arizona, Inc. |
| 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 | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $30 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $30 |
| 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 | $700 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $350 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $350 |
| 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 | No |
| Network ID | AZN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Only for palliative care where a network provider is not available. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 34095AZ0010001-00 |
| Plan Marketing Name | EssentialSmile 311 |
| Plan Type | EPO |
| Plan Variant Marketing Name | EssentialSmile 311 |
| QHP/Non QHP | Both |
| Service Area ID | AZS001 |
| Source Name | HIOS |
| Plan ID | 34095AZ0010001 |
| State Code | AZ |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
Copay & Coinsurance of EssentialSmile 311 Health Insurance Plan, 34095AZ0010001
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about EssentialSmile 311, 34095AZ0010001 Health Insurance Plan, 34095AZ0010001
-
Does EssentialSmile 311 Health Insurance Plan, 34095AZ0010001 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (34095AZ0010001) Health Insurance Plan, Variant (34095AZ0010001-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (34095AZ0010001) Health Insurance Plan, Variant (34095AZ0010001-00) have Out of Service Area Coverage?
Yes. Details: Only for palliative care where a network provider is not available.
Disclaimer: This is based on the import(Date: Tue, 23 Apr 2024 07:07 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