Choice PPO Basic Kids

66759NC0010005
Low
PPO

Choice PPO Basic Kids is a Low PPO plan by Dominion National.

Locations

Choice PPO Basic Kids is offered in the following counties.

Plan Overview

This is a plan overview for 2025 version of Choice PPO Basic Kids 66759NC0010005.
Insurer: Dominion National
Network Type: PPO
Metal Type: Low
HSA Eligible?:
Plan ID: 66759NC0010005

Cost-Sharing Overview

Choice PPO Basic Kids offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Choice PPO Basic Kids?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Choice PPO Basic Kids offers the following features and referral requirements.

Wellness Program:
Disease Program:
Notice Pregnancy:
Referral Specialist:
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Child-Only

Network Details

The following network details will help you understand what Choice PPO Basic Kids covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Standard Out of Network PPO Benefits
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Standard Out of Network PPO Benefits
National Network: Yes

Additional Benefits and Cost-Sharing

Choice PPO Basic Kids includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Routine Dental Services (Adult)
Dental Check-Up for Children
Covered
Not Applicable 0.00%Not Applicable 20.00%2.0 Visit(s) per Benefit Period
Basic Dental Care – Child
Covered
Not Applicable 65.00% Coinsurance after deductibleNot Applicable 80.00% Coinsurance after deductible
Orthodontia – Child
Covered
Not Applicable 50.00%Not Applicable 70.00%
Major Dental Care – Child
Covered
Not Applicable 75.00% Coinsurance after deductibleNot Applicable 90.00% Coinsurance after deductible
Basic Dental Care – Adult
Orthodontia – Adult
Major Dental Care – Adult
Accidental Dental
Covered
Not Applicable 65.00% Coinsurance after deductibleNot Applicable 80.00% Coinsurance after deductible

Free Preventive Services

There is no copayment or coinsurance for any of the following Choice PPO Basic Kids preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Ready to sign up for Choice PPO Basic Kids?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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