Accidental Dental
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Basic Dental Care - Adult
20.00% Coinsurance after deductible
Tier 1 in-network
20.00% Coinsurance after deductible
Out-of-network
30.00% Coinsurance after deductible
Limit: 1.0 Procedure(s) per 2 Years
Dental Check-Up for Children
0.00%
Tier 1 in-network
0.00%
Out-of-network
20.00%
Limit: 2.0 Visit(s) per Year
2 visits per year Includes coverage for D1110, D1120, D1203, D1204, D1206, and D1208.
Major Dental Care - Adult
50.00% Coinsurance after deductible
Tier 1 in-network
50.00% Coinsurance after deductible
Out-of-network
60.00% Coinsurance after deductible
Limit: 84.0 Months per Procedure
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
50.00%
Tier 1 in-network
50.00%
Out-of-network
70.00%
Exclusions: Orthodontia services are only provided for severe, dysfunctional, handicapping maloclussion.
Routine Dental Services (Adult)
0.00%
Tier 1 in-network
0.00%
Out-of-network
10.00%
Limit: 2.0 Visit(s) per Year