Flex with Ortho, EHB Certified - 31256MI0010006 Health Insurance Plan
DENCAP Dental Plans, Inc. health insurance plan with the Plan ID 31256MI0010006. The plan is called Flex with Ortho, EHB Certified.
| Health Insurance Plan ID | 31256MI0010006 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Michigan | ||||||||||||||||||
| Health Insurance Issuer | DENCAP Dental Plans, Inc. | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 31256MI0010006-00 | ||||||||||||||||||
| Provider Network(s) | ['MIN001'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Apr 2024 06:19 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Wed, 17 Aug 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Apr 2024 06:19 GMT |
Benefits of Flex with Ortho, EHB Certified Health Insurance Plan, 31256MI0010006-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
Limit: 100.0 Dollars per Year When 50 or more miles away from your selected General Dentist, DENCAP will reimburse 50% up to $100 for emergency services that relieve severe pain and are covered benefits. Click "Plan Brochure" above, then scroll to find the Schedule of Benefits for complete listing of covered services with co-pays. |
YES | $10.00, 20.00% |
50.00% |
| Basic Dental Care - Adult
Limit: 1200.0 Dollars per Year $1200 Primary Care (General Dentist) Maximum. Percentages are approximate. Your out of pocket (co-pay) payment to your Dentist is shown on the Schedule of Benefits. Click "Plan Brochure" above, then scroll to find the Schedule of Benefits for complete listing of covered services with co-pays. |
YES | $10.00, 30.00% |
100.00% |
| Basic Dental Care - Child
Limit: 1200.0 Dollars per Year $1200 Primary Care (General Dentist) Maximum. Maximuims and waiting periods are waived for EHB benefits. Percentages are approximate. Your out of pocket (co-pay) payment to your Dentist is shown on the Schedule of Benefits. Click "Plan Brochure" above, then scroll to find the Schedule of Benefits for complete listing of covered services with co-pays. |
YES | $10.00, 30.00% |
100.00% |
| Dental Check-Up for Children
Limit: 3.0 Visit(s) per Year Percentages are approximate. Your out of pocket (co-pay) payment to your Dentist is shown on the Schedule of Benefits. Maximuims and waiting periods are waived for EHB benefits. Click "Plan Brochure" above, then scroll to find the Schedule of Benefits for a complete listing of covered services with co-pays. |
YES | $10.00, No Charge |
100.00% |
| Major Dental Care - Adult
Limit: 1200.0 Dollars per Year $1200 Primary Care (General Dentist) Maximum. Percentages are approximate. Your out of pocket (co-pay) payment to your Dentist is shown on the Schedule of Benefits. Click "Plan Brochure" above, then scroll to find the Schedule of Benefits for complete listing of covered services with co-pays. |
YES | $10.00, 40.00% |
100.00% |
| Major Dental Care - Child
Limit: 1200.0 Dollars per Year $1200 Primary Care (General Dentist) Maximum. Maximuims and waiting periods are waived for EHB benefits. Percentages are approximate. Your out of pocket (co-pay) payment to your Dentist is shown on the Schedule of Benefits. Click "Plan Brochure" above, then scroll to find the Schedule of Benefits for complete listing of covered services with co-pays. |
YES | $10.00, 40.00% |
100.00% |
| Orthodontia - Adult
Limit: 1.0 Treatment(s) per Lifetime In-Network Orthodontists give an $1200 discount with referral from your General Dentist. |
YES | 65.00% |
100.00% |
| Orthodontia - Child
Limit: 1.0 Treatment(s) per Lifetime In-Network Orthodontists give an $1800 discount with referral from your General Dentist. |
YES | 65.00% |
100.00% |
| Routine Dental Services (Adult)
Limit: 2.0 Visit(s) per Year Percentages are approximate. Your out of pocket (co-pay) payment to your Dentist is shown on the Schedule of Benefits. Click "Plan Brochure" above, then scroll to find the Schedule of Benefits for a complete listing of covered services with co-pays. |
YES | $10.00, No Charge |
100.00% |
Flex with Ortho, EHB Certified Health Insurance Plan Variant 31256MI0010006-00 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 | 0.46 |
| First Tier Utilization | 100% |
| HIOS Product ID | 31256MI001 |
| Import Date | 8/17/2022 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 31256 |
| Issuer Marketplace Marketing Name | DENCAP Dental Plans, 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 | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| 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 | High |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MIN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | In-Network Dentstis outside of Service Area |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 31256MI0010006-00 |
| Plan Marketing Name | Flex with Ortho, EHB Certified |
| Plan Type | HMO |
| Plan Variant Marketing Name | Flex with Ortho, EHB Certified |
| QHP/Non QHP | Both |
| Service Area ID | MIS001 |
| Source Name | SERFF |
| Plan ID | 31256MI0010006 |
| State Code | MI |
Copay & Coinsurance of Flex with Ortho, EHB Certified Health Insurance Plan, 31256MI0010006
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Flex with Ortho, EHB Certified, 31256MI0010006 Health Insurance Plan, 31256MI0010006
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Does Flex with Ortho, EHB Certified Health Insurance Plan, 31256MI0010006 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (31256MI0010006) Health Insurance Plan, Variant (31256MI0010006-00) have Out Of Country Coverage?
Does (31256MI0010006) Health Insurance Plan, Variant (31256MI0010006-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 16 Apr 2024 06:19 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