EssentialSmile Ped 221 - 43274FL0010001 Health Insurance Plan

Solstice Benefits, Inc. health insurance plan with the Plan ID 43274FL0010001. The plan is called EssentialSmile Ped 221.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 43274FL0010001
Health Insurance Plan Year 2022
State Florida
Health Insurance Issuer Solstice Benefits, Inc.
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 43274FL0010001-00
Provider Network(s) ['FLN001']
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 Florida 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 - 43274FL0010001-00

Standard On Exchange Plan - 43274FL0010001-01

Last Plan Update Date Thu, 15 Jul 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

EssentialSmile Ped 221 Health Insurance Plan Variant 43274FL0010001-00 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 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 43274FL001
Import Date 7/15/2021 1:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer Actuarial Value 70.00%
Issuer ID 43274
Issuer Marketplace Marketing Name Solstice Benefits
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 $60
Medical EHB Deductible, Out of Network, Family Per Group per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person $60 per person
Medical EHB Deductible, Out of Network, Individual $60
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 Yes
Network ID FLN001
Out of Country Coverage Yes
Out of Country Coverage Description Available only for emergency services to treat an Emergency Condition.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description National Network of providers is available and members may also receive services at out of network providers.
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 43274FL0010001-00
Plan Marketing Name EssentialSmile Ped 221
Plan Type PPO
Plan Variant Marketing Name EssentialSmile Ped 221
QHP/Non QHP Both
Service Area ID FLS001
Source Name HIOS
Plan ID 43274FL0010001
State Code FL
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of EssentialSmile Ped 221 Health Insurance Plan, 43274FL0010001

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

Frequently Asked Questions(FAQ) about EssentialSmile Ped 221, 43274FL0010001 Health Insurance Plan, 43274FL0010001

  • Does EssentialSmile Ped 221 Health Insurance Plan, 43274FL0010001 support Mail Ordering?

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

  • Does (43274FL0010001) Health Insurance Plan, Variant (43274FL0010001-00) have Out Of Country Coverage?

    Yes. Details: Available only for emergency services to treat an Emergency Condition.

    Does (43274FL0010001) Health Insurance Plan, Variant (43274FL0010001-00) have Out of Service Area Coverage?

    Yes. Details: National Network of providers is available and members may also receive services at out of network 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