Tier 1 in-network
0.00%
Out-of-network
0.00%
Please refer to Plan Brochure for detailed services covered, not covered, and frequency limitations.
Exclusions: nan
Basic Dental Care - Adult
Coverage details pending
Dental Check-Up for Children
0.00%
Tier 1 in-network
0.00%
Out-of-network
0.00%
Limit: 1.0 Visit(s) per 6 Months
Dental Check-up is limited to 1 per 6 consecutive month period. Please refer to Plan Brochure for detailed services covered, not covered, and frequency limitations.
Exclusions: nan
Major Dental Care - Adult
Coverage details pending
Orthodontia - Child
50.00% Coinsurance after deductible
Tier 1 in-network
50.00% Coinsurance after deductible
Out-of-network
50.00% Coinsurance after deductible
Medically necessary only. Please refer to Plan Brochure for detailed services covered, not covered, and frequency limitations.
Exclusions: nan
Routine Dental Services (Adult)
Coverage details pending