Four Plan Options

Find the one that’s right for you! Let’s help you get the right plan!

 

Select who will be covered under your dental plan

Platinum Plan

couple coverage

$132.48
per month
Annual Maximum $2,500
Preventative (exams, cleanings) 100%
Basic (fillings, non-surgical extractions) 80%
Major (root canals, crowns, gum disease treatment) 70%
Implants 70%
Select

Gold Plan

couple coverage

$87.49
per month
Annual Maximum $1,500
Preventative (exams, cleanings) 100%
Basic (fillings, non-surgical extractions) 80%
Major (root canals, crowns, gum disease treatment) 50%
Implants N/A
Select

Silver Plan

couple coverage

$73.20
per month
Annual Maximum $1,000
Preventative (exams, cleanings) 100%
Basic (fillings, non-surgical extractions) 50%
Major (root canals, crowns, gum disease treatment) 50%
Implants N/A
Select

Bronze Plan

couple coverage

$65.14
per month
Annual Maximum $1,000
Preventative (exams, cleanings) 100%
Basic (fillings, non-surgical extractions) 80%
Major (root canals, crowns, gum disease treatment) N/A
Implants N/A
Select

Certain services listed above have frequencies and limitations.

Exclusions and Limitations: Following is a list of common non-covered services. For a complete list of exclusions and limitations, refer to your contract. Services which are available from any Federal or State government agency, or similar entity; services for injuries compensable under an automobile policy or worker’s compensation or similar employer coverage; cosmetic services (unless stated otherwise); services started prior to coverage; services that are not completed; administrative fees such as missed appointments; temporary services and procedures; duplicate dentures; prescription drugs, premedications and relative analgesia, including hospital, healthcare facility or medical emergency room charges; laboratory charges; anesthesia for restorative dentistry; preventive control programs; injuries or disease intentionally self inflicted or occurring during or as a result of participation in riots or civil disobedience of any form, acts of war, or criminal activity; appliances or restorations to restore occlusion, splinting, equilibration, or replace tooth structure lost by attrition; restorations in conjunction with overdenture; inlays and onlays; non-medically necessary orthodontic services; services provided outside of the United States or Canada; dental implants (except for the Platinum plan); services related to TMJ; and services, supplies or treatments not specifically listed as covered in the member’s contract. Limitations: Services are limited to the least costly professionally accepted treatment to achieve reasonable functionality; costs of the procedures necessary to prevent or eliminate oral disease and for appliances or restorations to replace missing teeth as allowed by the plan; frequency and combined service limitations related to restorations, individual crowns, prosthetic appliances, and periodontic procedures as identified within the contract; and other frequency, age or contractual limitations as specified. Benefits are allowed for a bilateral partial if teeth are missing in both quadrants of the same arch. See Benefit Booklet for further limitations.

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