| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0130001 | Delta Dental Premier, +2000, 100*/80/50, 50, PF | 21989AK013 | | AKN001 | AKS001 | | New | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0130001-00 | Delta Dental Premier, +2000, 100*/80/50, 50, PF | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2000_PF2_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | Individual | Yes | 93-0438772 | 21989AK0030001 | Delta Dental Premier Plan | 21989AK003 | | AKN001 | AKS001 | | Existing | Indemnity | Low | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | providers treated as out of network | Yes | national network | Yes | | | 21989AK0030001-00 | Delta Dental Premier Plan | Standard Low Off Exchange Plan | 71.69 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | Individual | Yes | 93-0438772 | 21989AK0030001 | Delta Dental Premier Plan | 21989AK003 | | AKN001 | AKS001 | | Existing | Indemnity | Low | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | providers treated as out of network | Yes | national network | Yes | | | 21989AK0030001-01 | Delta Dental Premier Plan | Standard Low On Exchange Plan | 71.69 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierPlan_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0130002 | Delta Dental Premier, +2500, 100*/80/50, 50, PF | 21989AK013 | | AKN001 | AKS001 | | New | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0130002-00 | Delta Dental Premier, +2500, 100*/80/50, 50, PF | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2500_PF2_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0080001 | Delta Dental Premier 1000, 100*/80/50, 50 | 21989AK008 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0080001-00 | Delta Dental Premier 1000, 100*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1000_100_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | Individual | Yes | 93-0438772 | 21989AK0050001 | Delta Dental PPO 1000 Plan | 21989AK005 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | National Network | Yes | Providers treated as out of network | Yes | | | 21989AK0050001-00 | Delta Dental PPO 1000 Plan | Standard High Off Exchange Plan | 83.95 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | Individual | Yes | 93-0438772 | 21989AK0050001 | Delta Dental PPO 1000 Plan | 21989AK005 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | National Network | Yes | Providers treated as out of network | Yes | | | 21989AK0050001-01 | Delta Dental PPO 1000 Plan | Standard High On Exchange Plan | 83.95 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1000Plan_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0080002 | Delta Dental Premier 1500, 100*/80/50, 50 | 21989AK008 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0080002-00 | Delta Dental Premier 1500, 100*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1500_100_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0080003 | Delta Dental Premier 2000, 100*/80/50, 50 | 21989AK008 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0080003-00 | Delta Dental Premier 2000, 100*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2000_100_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0090001 | Delta Dental Premier 1000, 80*/80/50, 50 | 21989AK009 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0090001-00 | Delta Dental Premier 1000, 80*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1000_80_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | Individual | Yes | 93-0438772 | 21989AK0050002 | Delta Dental PPO 1500 Plan | 21989AK005 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | providers treated as out of network | Yes | National Netwok | Yes | | | 21989AK0050002-00 | Delta Dental PPO 1500 Plan | Standard High Off Exchange Plan | 83.95 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | Individual | Yes | 93-0438772 | 21989AK0050002 | Delta Dental PPO 1500 Plan | 21989AK005 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | providers treated as out of network | Yes | National Netwok | Yes | | | 21989AK0050002-01 | Delta Dental PPO 1500 Plan | Standard High On Exchange Plan | 83.95 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPPO1500Plan_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0090001 | Delta Dental Premier 1000, 80*/80/50, 50 | 21989AK009 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0090001-01 | Delta Dental Premier 1000, 80*/80/50, 50 | Standard High On Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1000_80_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0090002 | Delta Dental Premier 1500, 80*/80/50, 50 | 21989AK009 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0090002-00 | Delta Dental Premier 1500, 80*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1500_80_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | Individual | Yes | 93-0438772 | 21989AK0070001 | Delta Dental Premier Healthy Smiles | 21989AK007 | | AKN001 | AKS001 | | Existing | Indemnity | Low | Not Applicable | | Off the Exchange | | | | | | No | Allows Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | Providers are treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0070001-00 | Delta Dental Premier Healthy Smiles | Standard Low Off Exchange Plan | 71.69 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $0 | $0 per person | $0 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/plans/individual/Moda_DeltaDentalPremierHealthySmilesPlan_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0090002 | Delta Dental Premier 1500, 80*/80/50, 50 | 21989AK009 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Both | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Guaranteed Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network. | Yes | National Network | Yes | | | 21989AK0090002-01 | Delta Dental Premier 1500, 80*/80/50, 50 | Standard High On Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier1500_80_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0090003 | Delta Dental Premier 2000, 80*/80/50, 50 | 21989AK009 | | AKN001 | AKS001 | | Existing | Indemnity | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0090003-00 | Delta Dental Premier 2000, 80*/80/50, 50 | Standard High Off Exchange Plan | 85.54 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | Not Applicable | per person not applicable | per group not applicable | | | | Not Applicable | per person not applicable | per group not applicable | $350 | $350 per person | $700 per group | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPremier2000_80_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0100001 | Delta Dental PPO 1000, 100*/90/50, 50 | 21989AK010 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0100001-00 | Delta Dental PPO 1000, 100*/90/50, 50 | Standard High Off Exchange Plan | 85.86 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPO1000_100_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0100002 | Delta Dental PPO 1500, 100*/90/50, 50 | 21989AK010 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0100002-00 | Delta Dental PPO 1500, 100*/90/50, 50 | Standard High Off Exchange Plan | 85.86 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPO1500_100_SG_2018_AK.pdf |
| 2018 | AK | 21989 | HIOS | 09/26/2017 02:21:00 AM | SHOP (Small Group) | Yes | 93-0438772 | 21989AK0100003 | Delta Dental PPO 2000, 100*/90/50, 50 | 21989AK010 | | AKN002 | AKS002 | | Existing | PPO | High | Not Applicable | | Off the Exchange | | | | | | No | Allows Adult and Child-Only | | | | | 1 | Estimated Rate | 01/01/2018 12:00:00 AM | | Yes | Providers treated as out-of-network | Yes | National Network | Yes | | | 21989AK0100003-00 | Delta Dental PPO 2000, 100*/90/50, 50 | Standard High Off Exchange Plan | 85.86 | | | | No | 100 | | | | | | | | | | | | | | | 0 | 0 | 0 | $350 | $350 per person | $700 per group | | | | Not Applicable | per person not applicable | per group not applicable | Not Applicable | per person not applicable | per group not applicable | | | | | | | | | | | | | | | | | | | | | | | | | Not Applicable | per person not applicable | per group not applicable | | | | | | Not Applicable | per person not applicable | per group not applicable | $50 | $50 per person | $150 per group | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | https://www.modahealth.com/pdfs/ben_sum/AK/170101/Moda_DeltaDentalPPO2000_100_SG_2018_AK.pdf |
