State Code
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County Name
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Metal Level
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Issuer Name
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Plan Id (Standard Component)
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Plan Marketing Name
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Plan Type
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Rating Area
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Child Only Offering
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Source
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Customer Service Phone Number Local
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Customer Service Phone Number Toll Free
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Customer Service Phone Number Tty
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Network Url
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Plan Brochure Url
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Summary Of Benefits Url
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Drug Formulary Url
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Routine Dental Services Adult 1
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Basic Dental Care Adult 1
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Major Dental Care Adult 1
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Orthodontia Adult 1
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Dental Check-Up For Children
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Basic Dental Care Child 1
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Major Dental Care Child 1
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Orthodontia Child 1
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Premium Rates
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Premium Child
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Premium Adult Individual Age 21
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Premium Adult Individual Age 27
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Premium Adult Individual Age 30
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Premium Adult Individual Age 40
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Premium Adult Individual Age 50
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Premium Adult Individual Age 60
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Premium Couple 21
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Premium Couple 30
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Premium Couple 40
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Premium Couple 50
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Premium Couple 60
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Couple+1 Child, Age 21
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Couple+1 Child, Age 30
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Couple+1 Child, Age 40
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Couple+1 Child, Age 50
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Couple+2 Children, Age 21
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Couple+2 Children, Age 30
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Couple+2 Children, Age 40
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Couple+2 Children, Age 50
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Couple+3 Or More Children, Age 21
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Couple+3 Or More Children, Age 30
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Couple+3 Or More Children, Age 40
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Couple+3 Or More Children, Age 50
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Individual+1 Child, Age 21
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Individual+1 Child, Age 30
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Individual+1 Child, Age 40
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Individual+1 Child, Age 50
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Individual+2 Children, Age 21
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Individual+2 Children, Age 30
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Individual+2 Children, Age 40
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Individual+2 Children, Age 50
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Individual+3 Or More Children, Age 21
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Individual+3 Or More Children, Age 30
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Individual+3 Or More Children, Age 40
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Individual+3 Or More Children, Age 50
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Standard On Exchange
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Dental Deductible - Individual - Standard
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Dental Deductible - Family - Standard
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Dental Deductible - Family (Per Person) - Standard
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Dental Maximum Out Of Pocket - Individual - Standard
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Dental Maximum Out Of Pocket - Family - Standard
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Dental Maximum Out Of Pocket - Family (Per Person) - Standard
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Routine Dental Services Adult
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Basic Dental Care Adult
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Major Dental Care Adult
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Orthodontia Adult
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Dental Checkup For Children
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Basic Dental Care Child
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Major Dental Care Child
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Orthodontia Child
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---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HI
|
Hawaii
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020001
|
HDS Individual Dental Plan for Children
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0715.pdf
|
X
|
X
|
X
|
X
|
31.2
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Honolulu
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020001
|
HDS Individual Dental Plan for Children
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0715.pdf
|
X
|
X
|
X
|
X
|
31.2
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Kauai
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020001
|
HDS Individual Dental Plan for Children
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0715.pdf
|
X
|
X
|
X
|
X
|
31.2
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Maui
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020001
|
HDS Individual Dental Plan for Children
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Individual_Dental_Plan_for_Children_0715.pdf
|
X
|
X
|
X
|
X
|
31.2
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Hawaii
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020003
|
BESTOne Advantage Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
62.07
|
66.31
|
66.31
|
66.31
|
66.31
|
66.31
|
124.14
|
132.62
|
132.62
|
132.62
|
132.62
|
180.26
|
188.74
|
188.74
|
188.74
|
236.38
|
244.86
|
244.86
|
244.86
|
292.5
|
300.98
|
300.98
|
300.98
|
118.19
|
122.43
|
122.43
|
122.43
|
174.31
|
178.55
|
178.55
|
178.55
|
230.43
|
234.67
|
234.67
|
234.67
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
10% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Hawaii
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020004
|
BESTOne Plus Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
51.59
|
55.12
|
55.12
|
55.12
|
55.12
|
55.12
|
103.18
|
110.24
|
110.24
|
110.24
|
110.24
|
159.3
|
166.36
|
166.36
|
166.36
|
215.42
|
222.48
|
222.48
|
222.48
|
271.54
|
278.6
|
278.6
|
278.6
|
107.71
|
111.24
|
111.24
|
111.24
|
163.83
|
167.36
|
167.36
|
167.36
|
219.95
|
223.48
|
223.48
|
223.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Hawaii
|
High
|
Hawaii Medical Service Association
|
18350HI0920001
|
HMSA Individual Dental PPP High
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
39.13
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
65.82
|
65.82
|
65.82
|
65.82
|
65.82
|
104.95
|
104.95
|
104.95
|
104.95
|
144.08
|
144.08
|
144.08
|
144.08
|
183.21
|
183.21
|
183.21
|
183.21
|
72.04
|
72.04
|
72.04
|
72.04
|
111.17
|
111.17
|
111.17
|
111.17
|
150.3
|
150.3
|
150.3
|
150.3
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
No Charge
|
30%
|
50%
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||
HI
|
Hawaii
|
Low
|
Hawaii Medical Service Association
|
18350HI0930001
|
HMSA Individual Dental HMO Basic
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
21.39
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
40.7
|
40.7
|
40.7
|
40.7
|
40.7
|
62.09
|
62.09
|
62.09
|
62.09
|
83.48
|
83.48
|
83.48
|
83.48
|
104.87
|
104.87
|
104.87
|
104.87
|
41.74
|
41.74
|
41.74
|
41.74
|
63.13
|
63.13
|
63.13
|
63.13
|
84.52
|
84.52
|
84.52
|
84.52
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
$10
|
$40
|
$250
|
Not Covered
|
$10
|
$40
|
$250
|
0.5
|
|||||||
HI
|
Honolulu
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020003
|
BESTOne Advantage Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
62.07
|
66.31
|
66.31
|
66.31
|
66.31
|
66.31
|
124.14
|
132.62
|
132.62
|
132.62
|
132.62
|
180.26
|
188.74
|
188.74
|
188.74
|
236.38
|
244.86
|
244.86
|
244.86
|
292.5
|
300.98
|
300.98
|
300.98
|
118.19
|
122.43
|
122.43
|
122.43
|
174.31
|
178.55
|
178.55
|
178.55
|
230.43
|
234.67
|
234.67
|
234.67
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
10% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Honolulu
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020004
|
BESTOne Plus Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
51.59
|
55.12
|
55.12
|
55.12
|
55.12
|
55.12
|
103.18
|
110.24
|
110.24
|
110.24
|
110.24
|
159.3
|
166.36
|
166.36
|
166.36
|
215.42
|
222.48
|
222.48
|
222.48
|
271.54
|
278.6
|
278.6
|
278.6
|
107.71
|
111.24
|
111.24
|
111.24
|
163.83
|
167.36
|
167.36
|
167.36
|
219.95
|
223.48
|
223.48
|
223.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Honolulu
|
High
|
Hawaii Medical Service Association
|
18350HI0920001
|
HMSA Individual Dental PPP High
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
39.13
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
65.82
|
65.82
|
65.82
|
65.82
|
65.82
|
104.95
|
104.95
|
104.95
|
104.95
|
144.08
|
144.08
|
144.08
|
144.08
|
183.21
|
183.21
|
183.21
|
183.21
|
72.04
|
72.04
|
72.04
|
72.04
|
111.17
|
111.17
|
111.17
|
111.17
|
150.3
|
150.3
|
150.3
|
150.3
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
No Charge
|
30%
|
50%
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||
HI
|
Honolulu
|
Low
|
Hawaii Medical Service Association
|
18350HI0930001
|
HMSA Individual Dental HMO Basic
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
21.39
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
40.7
|
40.7
|
40.7
|
40.7
|
40.7
|
62.09
|
62.09
|
62.09
|
62.09
|
83.48
|
83.48
|
83.48
|
83.48
|
104.87
|
104.87
|
104.87
|
104.87
|
41.74
|
41.74
|
41.74
|
41.74
|
63.13
|
63.13
|
63.13
|
63.13
|
84.52
|
84.52
|
84.52
|
84.52
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
$10
|
$40
|
$250
|
Not Covered
|
$10
|
$40
|
$250
|
0.5
|
|||||||
HI
|
Kauai
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020003
|
BESTOne Advantage Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
62.07
|
66.31
|
66.31
|
66.31
|
66.31
|
66.31
|
124.14
|
132.62
|
132.62
|
132.62
|
132.62
|
180.26
|
188.74
|
188.74
|
188.74
|
236.38
|
244.86
|
244.86
|
244.86
|
292.5
|
300.98
|
300.98
|
300.98
|
118.19
|
122.43
|
122.43
|
122.43
|
174.31
|
178.55
|
178.55
|
178.55
|
230.43
|
234.67
|
234.67
|
234.67
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
10% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Kauai
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020004
|
BESTOne Plus Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
51.59
|
55.12
|
55.12
|
55.12
|
55.12
|
55.12
|
103.18
|
110.24
|
110.24
|
110.24
|
110.24
|
159.3
|
166.36
|
166.36
|
166.36
|
215.42
|
222.48
|
222.48
|
222.48
|
271.54
|
278.6
|
278.6
|
278.6
|
107.71
|
111.24
|
111.24
|
111.24
|
163.83
|
167.36
|
167.36
|
167.36
|
219.95
|
223.48
|
223.48
|
223.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Kauai
|
High
|
Hawaii Medical Service Association
|
18350HI0920001
|
HMSA Individual Dental PPP High
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
39.13
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
65.82
|
65.82
|
65.82
|
65.82
|
65.82
|
104.95
|
104.95
|
104.95
|
104.95
|
144.08
|
144.08
|
144.08
|
144.08
|
183.21
|
183.21
|
183.21
|
183.21
|
72.04
|
72.04
|
72.04
|
72.04
|
111.17
|
111.17
|
111.17
|
111.17
|
150.3
|
150.3
|
150.3
|
150.3
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
No Charge
|
30%
|
50%
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||
HI
|
Kauai
|
Low
|
Hawaii Medical Service Association
|
18350HI0930001
|
HMSA Individual Dental HMO Basic
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
21.39
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
40.7
|
40.7
|
40.7
|
40.7
|
40.7
|
62.09
|
62.09
|
62.09
|
62.09
|
83.48
|
83.48
|
83.48
|
83.48
|
104.87
|
104.87
|
104.87
|
104.87
|
41.74
|
41.74
|
41.74
|
41.74
|
63.13
|
63.13
|
63.13
|
63.13
|
84.52
|
84.52
|
84.52
|
84.52
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
$10
|
$40
|
$250
|
Not Covered
|
$10
|
$40
|
$250
|
0.5
|
|||||||
HI
|
Maui
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020003
|
BESTOne Advantage Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Advantage-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
62.07
|
66.31
|
66.31
|
66.31
|
66.31
|
66.31
|
124.14
|
132.62
|
132.62
|
132.62
|
132.62
|
180.26
|
188.74
|
188.74
|
188.74
|
236.38
|
244.86
|
244.86
|
244.86
|
292.5
|
300.98
|
300.98
|
300.98
|
118.19
|
122.43
|
122.43
|
122.43
|
174.31
|
178.55
|
178.55
|
178.55
|
230.43
|
234.67
|
234.67
|
234.67
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
10% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Maui
|
High
|
BEST Life and Health Insurance Company
|
10046HI0020004
|
BESTOne Plus Gold
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Gold_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
56.12
|
51.59
|
55.12
|
55.12
|
55.12
|
55.12
|
55.12
|
103.18
|
110.24
|
110.24
|
110.24
|
110.24
|
159.3
|
166.36
|
166.36
|
166.36
|
215.42
|
222.48
|
222.48
|
222.48
|
271.54
|
278.6
|
278.6
|
278.6
|
107.71
|
111.24
|
111.24
|
111.24
|
163.83
|
167.36
|
167.36
|
167.36
|
219.95
|
223.48
|
223.48
|
223.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
30% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Maui
|
High
|
Hawaii Medical Service Association
|
18350HI0920001
|
HMSA Individual Dental PPP High
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
39.13
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
32.91
|
65.82
|
65.82
|
65.82
|
65.82
|
65.82
|
104.95
|
104.95
|
104.95
|
104.95
|
144.08
|
144.08
|
144.08
|
144.08
|
183.21
|
183.21
|
183.21
|
183.21
|
72.04
|
72.04
|
72.04
|
72.04
|
111.17
|
111.17
|
111.17
|
111.17
|
150.3
|
150.3
|
150.3
|
150.3
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
No Charge
|
30%
|
50%
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||
HI
|
Maui
|
Low
|
Hawaii Medical Service Association
|
18350HI0930001
|
HMSA Individual Dental HMO Basic
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
21.39
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
20.35
|
40.7
|
40.7
|
40.7
|
40.7
|
40.7
|
62.09
|
62.09
|
62.09
|
62.09
|
83.48
|
83.48
|
83.48
|
83.48
|
104.87
|
104.87
|
104.87
|
104.87
|
41.74
|
41.74
|
41.74
|
41.74
|
63.13
|
63.13
|
63.13
|
63.13
|
84.52
|
84.52
|
84.52
|
84.52
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
$10
|
$40
|
$250
|
Not Covered
|
$10
|
$40
|
$250
|
0.5
|
|||||||
HI
|
Hawaii
|
High
|
Hawaii Medical Service Association
|
18350HI0920005
|
HMSA Individual Dental PPP Pediatric Essential
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
39.37
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Hawaii
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
49.09
|
52.45
|
52.45
|
52.45
|
52.45
|
52.45
|
98.18
|
104.9
|
104.9
|
104.9
|
104.9
|
144.77
|
151.49
|
151.49
|
151.49
|
191.36
|
198.08
|
198.08
|
198.08
|
237.95
|
244.67
|
244.67
|
244.67
|
95.68
|
99.04
|
99.04
|
99.04
|
142.27
|
145.63
|
145.63
|
145.63
|
188.86
|
192.22
|
192.22
|
192.22
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Hawaii
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
35.3
|
37.71
|
37.71
|
37.71
|
37.71
|
37.71
|
70.6
|
75.42
|
75.42
|
75.42
|
75.42
|
117.19
|
122.01
|
122.01
|
122.01
|
163.78
|
168.6
|
168.6
|
168.6
|
210.37
|
215.19
|
215.19
|
215.19
|
81.89
|
84.3
|
84.3
|
84.3
|
128.48
|
130.89
|
130.89
|
130.89
|
175.07
|
177.48
|
177.48
|
177.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Hawaii
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020003
|
HDS Preferred Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
35.3
|
28.7
|
31.2
|
32.7
|
34.4
|
38.1
|
44.2
|
57.4
|
65.4
|
68.8
|
76.2
|
88.4
|
92.7
|
100.7
|
104.1
|
111.5
|
128
|
136
|
139.4
|
146.8
|
163.3
|
171.3
|
174.7
|
182.1
|
64
|
68
|
69.7
|
73.4
|
99.3
|
103.3
|
105
|
108.7
|
134.6
|
138.6
|
140.3
|
144
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Hawaii
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020004
|
HDS Classic Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.2
|
22.8
|
24.8
|
26.1
|
27.5
|
30.4
|
35.2
|
45.6
|
52.2
|
55
|
60.8
|
70.4
|
76.8
|
83.4
|
86.2
|
92
|
108
|
114.6
|
117.4
|
123.2
|
139.2
|
145.8
|
148.6
|
154.4
|
54
|
57.3
|
58.7
|
61.6
|
85.2
|
88.5
|
89.9
|
92.8
|
116.4
|
119.7
|
121.1
|
124
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Hawaii
|
Low
|
Hawaii Medical Service Association
|
18350HI0920002
|
HMSA Individual Dental PPP Basic
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
32.85
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
31.78
|
31.78
|
31.78
|
31.78
|
31.78
|
64.63
|
64.63
|
64.63
|
64.63
|
97.48
|
97.48
|
97.48
|
97.48
|
130.33
|
130.33
|
130.33
|
130.33
|
48.74
|
48.74
|
48.74
|
48.74
|
81.59
|
81.59
|
81.59
|
81.59
|
114.44
|
114.44
|
114.44
|
114.44
|
$25
|
See Plan Brochure
|
$25
|
350
|
700
|
350
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
Not Covered
|
Not Covered
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
60% Coinsurance after deductible
|
0.6
|
||||||||
HI
|
Honolulu
|
High
|
Hawaii Medical Service Association
|
18350HI0920005
|
HMSA Individual Dental PPP Pediatric Essential
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
39.37
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Honolulu
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
49.09
|
52.45
|
52.45
|
52.45
|
52.45
|
52.45
|
98.18
|
104.9
|
104.9
|
104.9
|
104.9
|
144.77
|
151.49
|
151.49
|
151.49
|
191.36
|
198.08
|
198.08
|
198.08
|
237.95
|
244.67
|
244.67
|
244.67
|
95.68
|
99.04
|
99.04
|
99.04
|
142.27
|
145.63
|
145.63
|
145.63
|
188.86
|
192.22
|
192.22
|
192.22
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Honolulu
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
35.3
|
37.71
|
37.71
|
37.71
|
37.71
|
37.71
|
70.6
|
75.42
|
75.42
|
75.42
|
75.42
|
117.19
|
122.01
|
122.01
|
122.01
|
163.78
|
168.6
|
168.6
|
168.6
|
210.37
|
215.19
|
215.19
|
215.19
|
81.89
|
84.3
|
84.3
|
84.3
|
128.48
|
130.89
|
130.89
|
130.89
|
175.07
|
177.48
|
177.48
|
177.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Honolulu
|
Low
|
Dentegra Insurance Company
|
50397HI0010006
|
Dentegra Dental PPO Family Basic Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
http://www.dentegra.com/find-a-dentist
|
http://www.dentegra.com/hcx/hi/50397hi0010006-16
|
X
|
X
|
X
|
X
|
X
|
X
|
25.63
|
27.27
|
27.27
|
27.27
|
27.27
|
27.27
|
27.27
|
54.54
|
54.54
|
54.54
|
54.54
|
54.54
|
80.17
|
80.17
|
80.17
|
80.17
|
105.8
|
105.8
|
105.8
|
105.8
|
131.43
|
131.43
|
131.43
|
131.43
|
52.9
|
52.9
|
52.9
|
52.9
|
78.53
|
78.53
|
78.53
|
78.53
|
104.16
|
104.16
|
104.16
|
104.16
|
$75
|
See Plan Brochure
|
Not Applicable
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
Not Covered
|
Not Covered
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||||||
HI
|
Honolulu
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020003
|
HDS Preferred Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
35.3
|
28.7
|
31.2
|
32.7
|
34.4
|
38.1
|
44.2
|
57.4
|
65.4
|
68.8
|
76.2
|
88.4
|
92.7
|
100.7
|
104.1
|
111.5
|
128
|
136
|
139.4
|
146.8
|
163.3
|
171.3
|
174.7
|
182.1
|
64
|
68
|
69.7
|
73.4
|
99.3
|
103.3
|
105
|
108.7
|
134.6
|
138.6
|
140.3
|
144
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Honolulu
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020004
|
HDS Classic Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.2
|
22.8
|
24.8
|
26.1
|
27.5
|
30.4
|
35.2
|
45.6
|
52.2
|
55
|
60.8
|
70.4
|
76.8
|
83.4
|
86.2
|
92
|
108
|
114.6
|
117.4
|
123.2
|
139.2
|
145.8
|
148.6
|
154.4
|
54
|
57.3
|
58.7
|
61.6
|
85.2
|
88.5
|
89.9
|
92.8
|
116.4
|
119.7
|
121.1
|
124
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Honolulu
|
Low
|
Hawaii Medical Service Association
|
18350HI0920002
|
HMSA Individual Dental PPP Basic
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
32.85
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
31.78
|
31.78
|
31.78
|
31.78
|
31.78
|
64.63
|
64.63
|
64.63
|
64.63
|
97.48
|
97.48
|
97.48
|
97.48
|
130.33
|
130.33
|
130.33
|
130.33
|
48.74
|
48.74
|
48.74
|
48.74
|
81.59
|
81.59
|
81.59
|
81.59
|
114.44
|
114.44
|
114.44
|
114.44
|
$25
|
See Plan Brochure
|
$25
|
350
|
700
|
350
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
Not Covered
|
Not Covered
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
60% Coinsurance after deductible
|
0.6
|
||||||||
HI
|
Kauai
|
High
|
Hawaii Medical Service Association
|
18350HI0920005
|
HMSA Individual Dental PPP Pediatric Essential
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
39.37
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Kauai
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
49.09
|
52.45
|
52.45
|
52.45
|
52.45
|
52.45
|
98.18
|
104.9
|
104.9
|
104.9
|
104.9
|
144.77
|
151.49
|
151.49
|
151.49
|
191.36
|
198.08
|
198.08
|
198.08
|
237.95
|
244.67
|
244.67
|
244.67
|
95.68
|
99.04
|
99.04
|
99.04
|
142.27
|
145.63
|
145.63
|
145.63
|
188.86
|
192.22
|
192.22
|
192.22
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Kauai
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
35.3
|
37.71
|
37.71
|
37.71
|
37.71
|
37.71
|
70.6
|
75.42
|
75.42
|
75.42
|
75.42
|
117.19
|
122.01
|
122.01
|
122.01
|
163.78
|
168.6
|
168.6
|
168.6
|
210.37
|
215.19
|
215.19
|
215.19
|
81.89
|
84.3
|
84.3
|
84.3
|
128.48
|
130.89
|
130.89
|
130.89
|
175.07
|
177.48
|
177.48
|
177.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Kauai
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020003
|
HDS Preferred Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
35.3
|
28.7
|
31.2
|
32.7
|
34.4
|
38.1
|
44.2
|
57.4
|
65.4
|
68.8
|
76.2
|
88.4
|
92.7
|
100.7
|
104.1
|
111.5
|
128
|
136
|
139.4
|
146.8
|
163.3
|
171.3
|
174.7
|
182.1
|
64
|
68
|
69.7
|
73.4
|
99.3
|
103.3
|
105
|
108.7
|
134.6
|
138.6
|
140.3
|
144
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Kauai
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020004
|
HDS Classic Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.2
|
22.8
|
24.8
|
26.1
|
27.5
|
30.4
|
35.2
|
45.6
|
52.2
|
55
|
60.8
|
70.4
|
76.8
|
83.4
|
86.2
|
92
|
108
|
114.6
|
117.4
|
123.2
|
139.2
|
145.8
|
148.6
|
154.4
|
54
|
57.3
|
58.7
|
61.6
|
85.2
|
88.5
|
89.9
|
92.8
|
116.4
|
119.7
|
121.1
|
124
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Kauai
|
Low
|
Hawaii Medical Service Association
|
18350HI0920002
|
HMSA Individual Dental PPP Basic
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
32.85
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
31.78
|
31.78
|
31.78
|
31.78
|
31.78
|
64.63
|
64.63
|
64.63
|
64.63
|
97.48
|
97.48
|
97.48
|
97.48
|
130.33
|
130.33
|
130.33
|
130.33
|
48.74
|
48.74
|
48.74
|
48.74
|
81.59
|
81.59
|
81.59
|
81.59
|
114.44
|
114.44
|
114.44
|
114.44
|
$25
|
See Plan Brochure
|
$25
|
350
|
700
|
350
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
Not Covered
|
Not Covered
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
60% Coinsurance after deductible
|
0.6
|
||||||||
HI
|
Maui
|
High
|
Hawaii Medical Service Association
|
18350HI0920005
|
HMSA Individual Dental PPP Pediatric Essential
|
PPO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
39.37
|
$0
|
$0
|
$0
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
30%
|
50%
|
0.5
|
|||||||||||||||||||||||||||||||||||||||||||||
HI
|
Maui
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
49.09
|
52.45
|
52.45
|
52.45
|
52.45
|
52.45
|
98.18
|
104.9
|
104.9
|
104.9
|
104.9
|
144.77
|
151.49
|
151.49
|
151.49
|
191.36
|
198.08
|
198.08
|
198.08
|
237.95
|
244.67
|
244.67
|
244.67
|
95.68
|
99.04
|
99.04
|
99.04
|
142.27
|
145.63
|
145.63
|
145.63
|
188.86
|
192.22
|
192.22
|
192.22
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Maui
|
Low
|
BEST Life and Health Insurance Company
|
10046HI0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/provider.html
|
https://www.bestlife.com/HI/2015/HI_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
46.59
|
35.3
|
37.71
|
37.71
|
37.71
|
37.71
|
37.71
|
70.6
|
75.42
|
75.42
|
75.42
|
75.42
|
117.19
|
122.01
|
122.01
|
122.01
|
163.78
|
168.6
|
168.6
|
168.6
|
210.37
|
215.19
|
215.19
|
215.19
|
81.89
|
84.3
|
84.3
|
84.3
|
128.48
|
130.89
|
130.89
|
130.89
|
175.07
|
177.48
|
177.48
|
177.48
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
0.5
|
|||||
HI
|
Maui
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020003
|
HDS Preferred Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Preferred_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
35.3
|
28.7
|
31.2
|
32.7
|
34.4
|
38.1
|
44.2
|
57.4
|
65.4
|
68.8
|
76.2
|
88.4
|
92.7
|
100.7
|
104.1
|
111.5
|
128
|
136
|
139.4
|
146.8
|
163.3
|
171.3
|
174.7
|
182.1
|
64
|
68
|
69.7
|
73.4
|
99.3
|
103.3
|
105
|
108.7
|
134.6
|
138.6
|
140.3
|
144
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Maui
|
Low
|
Hawaii Dental Service Corporation
|
46082HI0020004
|
HDS Classic Dental Plan
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-521-1431
|
https://www.hawaiidentalservice.com/ddpahi/HtmlPage.jsp?DView=providerSearch
|
http://www.hawaiidentalservice.com/ddpahi/Form_HDS_Classic_Dental_Plan_0715.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.2
|
22.8
|
24.8
|
26.1
|
27.5
|
30.4
|
35.2
|
45.6
|
52.2
|
55
|
60.8
|
70.4
|
76.8
|
83.4
|
86.2
|
92
|
108
|
114.6
|
117.4
|
123.2
|
139.2
|
145.8
|
148.6
|
154.4
|
54
|
57.3
|
58.7
|
61.6
|
85.2
|
88.5
|
89.9
|
92.8
|
116.4
|
119.7
|
121.1
|
124
|
$50
|
See Plan Brochure
|
$50
|
350
|
700
|
350
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
70% Coinsurance after deductible
|
70% Coinsurance after deductible
|
0.5
|
|||||||
HI
|
Maui
|
Low
|
Hawaii Medical Service Association
|
18350HI0920002
|
HMSA Individual Dental PPP Basic
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-808-948-5555
|
1-800-620-4672
|
http://www.hmsa.com/search/providers
|
X
|
X
|
X
|
X
|
X
|
X
|
32.85
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
15.89
|
31.78
|
31.78
|
31.78
|
31.78
|
31.78
|
64.63
|
64.63
|
64.63
|
64.63
|
97.48
|
97.48
|
97.48
|
97.48
|
130.33
|
130.33
|
130.33
|
130.33
|
48.74
|
48.74
|
48.74
|
48.74
|
81.59
|
81.59
|
81.59
|
81.59
|
114.44
|
114.44
|
114.44
|
114.44
|
$25
|
See Plan Brochure
|
$25
|
350
|
700
|
350
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
Not Covered
|
Not Covered
|
10% Coinsurance after deductible
|
40% Coinsurance after deductible
|
60% Coinsurance after deductible
|
0.6
|
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