Guardian Choice for Families and Individuals - 34028UT0070005 Health Insurance Plan
Guardian Life Insurance Company of America health insurance plan with the Plan ID 34028UT0070005. The plan is called Guardian Choice for Families and Individuals .
| Health Insurance Plan ID | 34028UT0070005 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Utah | ||||||||||||||||||
| Health Insurance Issuer | Guardian Life Insurance Company of America | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 34028UT0070005-00 | ||||||||||||||||||
| Provider Network(s) | ['UTN001'] | ||||||||||||||||||
| 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 Guardian Choice for Families and Individuals Health Insurance Plan, 34028UT0070005-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
NO | ||
| Basic Dental Care - Adult
Waiting period, deductible and annual maximum applies. See Schedule of Benefits. |
YES | 20.00% Coinsurance after deductible |
20.00% Coinsurance after deductible |
| Basic Dental Care - Child
Deductible and annual maximum applies. See Schedule of Benefits. |
YES | 30.00% Coinsurance after deductible |
30.00% Coinsurance after deductible |
| Dental Check-Up for Children
Limit: 2.0 Procedure(s) per Benefit Period Routine cleaning, exams, x-rays and fluoride. Sealants once every five years. |
YES | 30.00% |
30.00% |
| Major Dental Care - Adult
Waiting period, deductible and annual maximum applies. See Schedule of Benefits. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Major Dental Care - Child
Deductible and annual maximum applies. See Schedule of Benefits. |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Waiting period and lifetime maximum applies. See Schedule of Benefits. |
YES | 50.00% |
50.00% |
| Routine Dental Services (Adult)
Deductible and annual maximum applies. |
YES | No Charge after deductible |
No Charge after deductible |
Guardian Choice for Families and Individuals Health Insurance Plan Variant 34028UT0070005-00 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 Low Off Exchange Plan |
| Dental Only Plan | Yes |
| EHB Apportionment for Pediatric Dental | 0.598 |
| First Tier Utilization | 100% |
| HIOS Product ID | 34028UT007 |
| Import Date | 8/17/2022 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | New |
| Issuer ID | 34028 |
| Issuer Marketplace Marketing Name | Guardian |
| 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 | 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 | UTN001 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage is provided outside of the Service Area. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 34028UT0070005-00 |
| Plan Marketing Name | Guardian Choice for Families and Individuals |
| Plan Type | PPO |
| Plan Variant Marketing Name | Guardian Choice for Families and Individuals |
| QHP/Non QHP | Both |
| Service Area ID | UTS001 |
| Source Name | SERFF |
| Plan ID | 34028UT0070005 |
| State Code | UT |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of Guardian Choice for Families and Individuals Health Insurance Plan, 34028UT0070005
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Guardian Choice for Families and Individuals , 34028UT0070005 Health Insurance Plan, 34028UT0070005
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Does Guardian Choice for Families and Individuals Health Insurance Plan, 34028UT0070005 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (34028UT0070005) Health Insurance Plan, Variant (34028UT0070005-00) have Out Of Country Coverage?
Does (34028UT0070005) Health Insurance Plan, Variant (34028UT0070005-00) 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