DentaQuest EPO Pediatric High - 43878TN0010001 Health Insurance Plan

DentaQuest USA Insurance Company, Inc. health insurance plan with the Plan ID 43878TN0010001. The plan is called DentaQuest EPO Pediatric High.

Health Insurance Plan ID 43878TN0010001
Health Insurance Plan Year 2023
State Tennessee
Health Insurance Issuer DentaQuest USA Insurance Company, Inc.
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 43878TN0010001-00
Provider Network(s) ['TNN001']
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 Tennessee 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 - 43878TN0010001-00

Standard On Exchange Plan - 43878TN0010001-01

Last Plan Update Date Tue, 17 May 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of DentaQuest EPO Pediatric High Health Insurance Plan, 43878TN0010001-00

Benefit Covered In Network Out Of Network
Accidental Dental

Limit: 1.0 Treatment(s) per Episode

limit of service varies based upon procedure, see summary of benefits for additional information

YES

No Charge

No Charge
Basic Dental Care - Adult
NO
Basic Dental Care - Child
YES

20.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

YES

No Charge

100.00%
Major Dental Care - Adult
NO
Major Dental Care - Child

Limit: 1.0 Item(s) per 3 Years

limit of service varies based upon procedure, see summary of benefits for additional information

YES

50.00% Coinsurance after deductible

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
YES

50.00%

100.00%
Routine Dental Services (Adult)
NO

DentaQuest EPO Pediatric High Health Insurance Plan Variant 43878TN0010001-00 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 Child-Only
Composite Rating Offered No
CSR Variation Type Standard High Off Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1
First Tier Utilization 100%
HIOS Product ID 43878TN001
Import Date 5/17/2022 1:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 43878
Issuer Marketplace Marketing Name DentaQuest Insurance Company Inc- TN
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 $150 per group
Medical EHB Deductible, In Network (Tier 1), Family Per Person $50 per person
Medical EHB Deductible, In Network (Tier 1), Individual $50
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 $700 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person $350 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual $350
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 TNN001
Out of Country Coverage No
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Only. In excess of 50 miles from nearest provider.
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 43878TN0010001-00
Plan Marketing Name DentaQuest EPO Pediatric High
Plan Type EPO
Plan Variant Marketing Name DentaQuest EPO Pediatric High
QHP/Non QHP Both
Service Area ID TNS001
Source Name HIOS
Plan ID 43878TN0010001
State Code TN
URL for Enrollment Payment URL

Copay & Coinsurance of DentaQuest EPO Pediatric High Health Insurance Plan, 43878TN0010001

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

Frequently Asked Questions(FAQ) about DentaQuest EPO Pediatric High, 43878TN0010001 Health Insurance Plan, 43878TN0010001

  • Does DentaQuest EPO Pediatric High Health Insurance Plan, 43878TN0010001 support Mail Ordering?

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

  • Does (43878TN0010001) Health Insurance Plan, Variant (43878TN0010001-00) have Out Of Country Coverage?

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

    Does (43878TN0010001) Health Insurance Plan, Variant (43878TN0010001-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Only. In excess of 50 miles from nearest provider.

 

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