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

whole family coverage

$188.79
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

whole family coverage

$124.67
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

whole family coverage

$104.29
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

whole family coverage

$92.82
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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