EssentialSmile 511 - 57086OH0010001 Health Insurance Plan

Solstice Healthplans of Ohio, Inc. health insurance plan with the Plan ID 57086OH0010001. The plan is called EssentialSmile 511.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.70% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.30% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 57086OH0010001
Health Insurance Plan Year 2022
State Ohio
Health Insurance Issuer Solstice Healthplans of Ohio, Inc.
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 57086OH0010001-00
Provider Network(s) ['OHN001']
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 Ohio 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 - 57086OH0010001-00

Standard On Exchange Plan - 57086OH0010001-01

Last Plan Update Date Mon, 16 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

EssentialSmile 511 Health Insurance Plan Variant 57086OH0010001-00 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 2022
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 57086OH001
Import Date 8/16/2021 20:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan New
Issuer Actuarial Value 70.70%
Issuer ID 57086
Issuer Marketplace Marketing Name Solstice Healthplans of Ohio, 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 Low
Multiple In Network Tiers No
National Network No
Network ID OHN001
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 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 57086OH0010001-00
Plan Marketing Name EssentialSmile 511
Plan Type EPO
Plan Variant Marketing Name EssentialSmile 511
QHP/Non QHP Both
Service Area ID OHS001
Source Name SERFF
Plan ID 57086OH0010001
State Code OH
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of EssentialSmile 511 Health Insurance Plan, 57086OH0010001

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

Frequently Asked Questions(FAQ) about EssentialSmile 511, 57086OH0010001 Health Insurance Plan, 57086OH0010001

  • Does EssentialSmile 511 Health Insurance Plan, 57086OH0010001 support Mail Ordering?

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

  • Does (57086OH0010001) Health Insurance Plan, Variant (57086OH0010001-00) have Out Of Country Coverage?

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

    Does (57086OH0010001) Health Insurance Plan, Variant (57086OH0010001-00) 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: 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