Guardian Select for Families and Individuals - 42808VA0270002 Health Insurance Plan

The Guardian Life Insurance Company of America health insurance plan with the Plan ID 42808VA0270002. The plan is called Guardian Select for Families and Individuals .

Health Insurance Plan ID 42808VA0270002
Health Insurance Plan Year 2023
State Virginia
Health Insurance Issuer The Guardian Life Insurance Company of America
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 42808VA0270002-00
Provider Network(s) ['VAN002']
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 Virginia 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 - 42808VA0270002-00

Standard On Exchange Plan - 42808VA0270002-01

Last Plan Update Date Fri, 12 Aug 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Guardian Select for Families and Individuals Health Insurance Plan, 42808VA0270002-00

Benefit Covered In Network Out Of Network
Accidental Dental

Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Basic Dental Care - Adult

Services are subject to an annual deductible and maximum. The in network deductible is $60. The out of network deductible is $120. The annual maximum is $800. A 6 month waiting period applies.

YES

40.00% Coinsurance after deductible

60.00% Coinsurance after deductible
Basic Dental Care - Child

Benefit limitations may apply to individual services.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 1.0 Treatment(s) per 6 Months

Includes coverage for D1110, D1120, D1203, D1204, D1206, and D1208.

YES

No Charge after deductible

No Charge after deductible
Major Dental Care - Adult

Services are subject to an annual deductible and maximum. The in network deductible is $60. The out of network deductible is $120. The annual maximum is $800. A 12 month waiting period applies.

YES

50.00% Coinsurance after deductible

70.00% Coinsurance after deductible
Major Dental Care - Child

Benefit limitations may apply to individual services.

YES

50.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child
YES

50.00%

100.00%
Routine Dental Services (Adult)

Services are subject to an annual deductible and maximum. The in network deductible is $60. The out of network deductible is $120. The annual maximum is $800.

YES

No Charge after deductible

30.00% Coinsurance after deductible

Guardian Select for Families and Individuals Health Insurance Plan Variant 42808VA0270002-00 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 1
First Tier Utilization 100%
HIOS Product ID 42808VA027
Import Date 8/12/2022 20:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 42808
Issuer Marketplace Marketing Name The Guardian Life Insurance Company of America
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 $60 per person
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 $120 per person
Medical EHB Deductible, Out of Network, Individual $120
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 VAN002
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) 42808VA0270002-00
Plan Marketing Name Guardian Select for Families and Individuals
Plan Type PPO
Plan Variant Marketing Name Guardian Select for Families and Individuals
QHP/Non QHP Both
Service Area ID VAS001
Source Name SERFF
Plan ID 42808VA0270002
State Code VA
URL for Enrollment Payment URL

Copay & Coinsurance of Guardian Select for Families and Individuals Health Insurance Plan, 42808VA0270002

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

Frequently Asked Questions(FAQ) about Guardian Select for Families and Individuals , 42808VA0270002 Health Insurance Plan, 42808VA0270002

  • Does Guardian Select for Families and Individuals Health Insurance Plan, 42808VA0270002 support Mail Ordering?

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

  • Does (42808VA0270002) Health Insurance Plan, Variant (42808VA0270002-00) have Out Of Country Coverage?

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

    Does (42808VA0270002) Health Insurance Plan, Variant (42808VA0270002-00) have Out of Service Area Coverage?

    Yes. Details: Coverage is provided outside of the Service Area.

 

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