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DentaTrust PPO Family Basic Option - 38886TN0070005 Health Insurance Plan

Dental Care Plus, Inc. health insurance plan with the Plan ID 38886TN0070005. The plan is called DentaTrust PPO Family Basic Option.

Field Data
Health Insurance Plan ID38886TN0070005
Health Insurance Plan Year2022
StateTennessee
Health Insurance IssuerDental Care Plus, Inc.
Plan Marketing Materials URLMarketing URL
Last Plan Update DateTue, 18 May 2021 00:00 GMT
Last Import DateSun, 24 Sep 2023 09:34 GMT
Health Insurance Plan Variant38886TN0070005-00
 
Available Variants of the Health Plan

38886TN0070005-00

38886TN0070005-01

DentaTrust PPO Family Basic Option Health Insurance Plan Variant 38886TN0070005-00 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits0
Begin Primary Care Deductible Coinsurance After Number Of Copays0
Business Year2022
Child-Only OfferingAllows Adult and Child-Only
Composite Rating OfferedNo
CSR Variation TypeStandard Low Off Exchange Plan
Dental Only PlanYes
EHB Apportionment for Pediatric Dental1
First Tier Utilization100%
HIOS Product ID38886TN007
Import Date5/18/2021 1:00
Inpatient Copayment Maximum Days0
Guaranteed RateGuaranteed Rate
New/Existing PlanExisting
Issuer ID38886
Issuer Marketplace Marketing NameDentaTrust/DentaSpan
Market CoverageIndividual
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Groupper group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Personper 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$150 per group
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 Groupper group not applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Personper person not applicable
Medical EHB Deductible, In Network (Tier 1), IndividualNot Applicable
Medical EHB Deductible, Out of Network, Family Per Groupper group not applicable
Medical EHB Deductible, Out of Network, Family Per Personper person not applicable
Medical EHB Deductible, Out of Network, IndividualNot 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 Groupper group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, IndividualNot Applicable
Metal LevelLow
Multiple In Network TiersNo
National NetworkNo
Network IDTNN001
Out of Country CoverageNo
Out of Service Area CoverageYes
Out of Service Area Coverage DescriptionOut-of-Network coverage is available for covered services obtained from non-participating dentists. See the schedule of benefits for out-of-network coverage levels.
Plan BrochureURL
Plan Effective Date1/1/2022
Plan Expiration Date12/31/2022
Plan ID (Standard Component ID with Variant) 38886TN0070005-00
Plan Level ExclusionsPlease refer to the exclusions listed in the Plan Brochure for specific plan level exclusions
Plan Marketing NameDentaTrust PPO Family Basic Option
Plan TypePPO
Plan Variant Marketing NameDentaTrust PPO Family Basic Option
QHP/Non QHPBoth
Service Area IDTNS001
Source NameHIOS
Plan ID38886TN0070005
State CodeTN
URL for Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL

Copay & Coinsurance of DentaTrust PPO Family Basic Option Health Insurance Plan, 38886TN0070005

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

Frequently Asked Questions(FAQ) about DentaTrust PPO Family Basic Option, 38886TN0070005 Health Insurance Plan, 38886TN0070005

Does DentaTrust PPO Family Basic Option Health Insurance Plan, 38886TN0070005 support Mail Ordering?

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

Does (38886TN0070005) Health Insurance Plan, Variant (38886TN0070005-00) have Out Of Country Coverage?

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

Does (38886TN0070005) Health Insurance Plan, Variant (38886TN0070005-00) have Out of Service Area Coverage?

Yes. Details: Out-of-Network coverage is available for covered services obtained from non-participating dentists. See the schedule of benefits for out-of-network coverage levels.

 

Disclaimer: This is based on the import(Date: Sun, 24 Sep 2023 09:34 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