HDS Preferred Dental Plan - 46082HI0020003 Health Insurance Plan

Hawaii Dental Service health insurance plan with the Plan ID 46082HI0020003. The plan is called HDS Preferred Dental Plan.

Health Insurance Plan ID 46082HI0020003
Health Insurance Plan Year 2022
State Hawaii
Health Insurance Issuer Hawaii Dental Service
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 46082HI0020003-00
Provider Network(s) ['HIN001']
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 Hawaii 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 - 46082HI0020003-00

Standard On Exchange Plan - 46082HI0020003-01

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

HDS Preferred Dental Plan Health Insurance Plan Variant 46082HI0020003-00 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 0.8571
First Tier Utilization 100%
HIOS Product ID 46082HI002
Import Date 6/16/2021 20:00
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 46082
Issuer Marketplace Marketing Name Hawaii Dental Service
Market Coverage Individual
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group $750 per group
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person $375 per person
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out $375
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 $50 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $50
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 per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual Not Applicable
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 HIN001
Out of Country Coverage Yes
Out of Country Coverage Description For services received outside of the country, member will pay the claim in full at the time of service. Member is responsible to submit the claim to HDS translated into English and U.S. Dollars. HDS will reimburse the member based on a non participating dentist fee schedule.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Service area includes: Hawaii, Guam and Saipan. For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist. The Delta Dentist will submit claim directly to HDS. Member out-of-pocket share will be in accordance to the plan benefits.
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 46082HI0020003-00
Plan Level Exclusions Services for injuries and conditions that are covered under Workers' Compensation or Employer's Liability Laws; Services provided by any federal or state government agency or those provided without cost to the eligible person by the government or any agency or instrumentality of the government; Congenital malformations, medically related problems, cosmetic surgery or dentistry for cosmetic reasons; Procedures, appliances or restorations other than those for replacement of structure loss from cavities that are necessary to alter, restore or maintain occlusion; Treatment of disturbances of the temporomandibular joint; Implants; All prescription medication; Hawaii general excise tax imposed or incurred in connection with any fees charged, whether or not passed on to a patient by a dentist; All transportation costs; Other exclusions may apply.
Plan Marketing Name HDS Preferred Dental Plan
Plan Type PPO
Plan Variant Marketing Name HDS Preferred Dental Plan
QHP/Non QHP Both
Service Area ID HIS001
Source Name SERFF
Plan ID 46082HI0020003
State Code HI
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of HDS Preferred Dental Plan Health Insurance Plan, 46082HI0020003

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

Frequently Asked Questions(FAQ) about HDS Preferred Dental Plan, 46082HI0020003 Health Insurance Plan, 46082HI0020003

  • Does HDS Preferred Dental Plan Health Insurance Plan, 46082HI0020003 support Mail Ordering?

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

  • Does (46082HI0020003) Health Insurance Plan, Variant (46082HI0020003-00) have Out Of Country Coverage?

    Yes. Details: For services received outside of the country, member will pay the claim in full at the time of service. Member is responsible to submit the claim to HDS translated into English and U.S. Dollars. HDS will reimburse the member based on a non participating dentist fee schedule.

    Does (46082HI0020003) Health Insurance Plan, Variant (46082HI0020003-00) have Out of Service Area Coverage?

    Yes. Details: Service area includes: Hawaii, Guam and Saipan. For services received on the Mainland (Continental U.S), the maximum benefit from the plan is received when visiting a Delta Dental participating dentist. The Delta Dentist will submit claim directly to HDS. Member out-of-pocket share will be in accordance to the plan benefits.

 

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