DentaQuest Family Low - 40198VA0020008 Health Insurance Plan
DSM USA Insurance Company Inc health insurance plan with the Plan ID 40198VA0020008. The plan is called DentaQuest Family Low.
| Health Insurance Plan ID | 40198VA0020008 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | Virginia | ||||||||||||||||||
| Health Insurance Issuer | DSM USA Insurance Company Inc | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 40198VA0020008-00 | ||||||||||||||||||
| Provider Network(s) | ['VAN003'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Apr 2024 06:19 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 15 Aug 2022 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Apr 2024 06:19 GMT |
Benefits of DentaQuest Family Low Health Insurance Plan, 40198VA0020008-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Accidental Dental
|
YES | 60.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Basic Dental Care - Adult
These services have a 6 month waiting period. Limit of service varies based upon procedure, see summary of benefits for additional information. The deductible of $50 per person/$150 maximum applies to both adult and pediatric services. Benefit Maximums depend upon the plan chosen; Family HIGH $1,500/ calendar year Family LOW $1,000/calendar year |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Basic Dental Care - Child
Benefit limitations may apply to individual services. |
YES | 60.00% Coinsurance after deductible |
60.00% 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 |
No Charge |
| Major Dental Care - Adult
Limit: 1.0 Item(s) per 3 Years These services have a 12 month waiting period. Limit of service varies based upon procedure, see summary of benefits for additional information. The deductible of $50 per person/$150 maximum applies to both adult and pediatric services. Benefit Maximums depend upon the plan chosen; Family HIGH $1,500/ calendar year Family LOW $1,000/calendar year |
YES | 50.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Major Dental Care - Child
Benefit limitations may apply to individual services. |
YES | 60.00% Coinsurance after deductible |
60.00% Coinsurance after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Limit: 1.0 Treatment(s) per Lifetime Limit applies to one comprehensive orthodontic treatment of the adolescent dentition. |
YES | 60.00% |
60.00% |
| Routine Dental Services (Adult)
Limit: 2.0 Visit(s) per Year Frequency, 2 vistis per year. No waiting period. The deductible applies to both adult and pediatric services. Benefit Maximums depend upon the plan chosen; Family HIGH $1,500/ calendar year Family LOW $1,000/calendar year |
YES | No Charge |
No Charge |
DentaQuest Family Low Health Insurance Plan Variant 40198VA0020008-00 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 | 40198VA002 |
| Import Date | 8/15/2022 20:01 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer ID | 40198 |
| Issuer Marketplace Marketing Name | DSM USA Insurance Company Inc |
| 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 | $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 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 | $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 | Low |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | VAN003 |
| 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) | 40198VA0020008-00 |
| Plan Marketing Name | DentaQuest Family Low |
| Plan Type | PPO |
| Plan Variant Marketing Name | DentaQuest Family Low |
| QHP/Non QHP | Both |
| Service Area ID | VAS002 |
| Source Name | SERFF |
| Plan ID | 40198VA0020008 |
| State Code | VA |
| URL for Enrollment Payment | URL |
Copay & Coinsurance of DentaQuest Family Low Health Insurance Plan, 40198VA0020008
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about DentaQuest Family Low, 40198VA0020008 Health Insurance Plan, 40198VA0020008
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Does DentaQuest Family Low Health Insurance Plan, 40198VA0020008 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (40198VA0020008) Health Insurance Plan, Variant (40198VA0020008-00) have Out Of Country Coverage?
Does (40198VA0020008) Health Insurance Plan, Variant (40198VA0020008-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 16 Apr 2024 06:19 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