Managed DentalGuard IL Essentials 1 - 87304IL0060007 Health Insurance Plan

First Commonwealth Insurance Company health insurance plan with the Plan ID 87304IL0060007. The plan is called Managed DentalGuard IL Essentials 1.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 72.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 28.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 87304IL0060007
Health Insurance Plan Year 2022
State Illinois
Health Insurance Issuer First Commonwealth Insurance Company
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 87304IL0060007-00
Provider Network(s) ['ILN002']
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 Illinois 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 - 87304IL0060007-00

Standard On Exchange Plan - 87304IL0060007-01

Last Plan Update Date Wed, 18 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Managed DentalGuard IL Essentials 1 Health Insurance Plan Variant 87304IL0060007-00 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 0.963
First Tier Utilization 100%
HIOS Product ID 87304IL006
Import Date 8/18/2021 20:00
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan New
Issuer Actuarial Value 72.00%
Issuer ID 87304
Issuer Marketplace Marketing Name First Commonwealth Insurance Company
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 No
Network ID ILN002
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan ID (Standard Component ID with Variant) 87304IL0060007-00
Plan Marketing Name Managed DentalGuard IL Essentials 1
Plan Type HMO
Plan Variant Marketing Name Managed DentalGuard IL Essentials 1
QHP/Non QHP Both
Service Area ID ILS001
Source Name SERFF
Plan ID 87304IL0060007
State Code IL
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL

Copay & Coinsurance of Managed DentalGuard IL Essentials 1 Health Insurance Plan, 87304IL0060007

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

Frequently Asked Questions(FAQ) about Managed DentalGuard IL Essentials 1, 87304IL0060007 Health Insurance Plan, 87304IL0060007

  • Does Managed DentalGuard IL Essentials 1 Health Insurance Plan, 87304IL0060007 support Mail Ordering?

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

  • Does (87304IL0060007) Health Insurance Plan, Variant (87304IL0060007-00) have Out Of Country Coverage?

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

    Does (87304IL0060007) Health Insurance Plan, Variant (87304IL0060007-00) have Out of Service Area Coverage?

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

 

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