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
50.00% Coinsurance after deductible
All dental services are subject to an annual maximum of $1,500. See policy for other limits. A 6-month exclusion period applies except if the member has one year of prior dental coverage with no more than a 90-day break in coverage from the end of the old plicy to the effective date of the new policy.
Exclusions: See policy for exclusions.
Dental Check-Up for Children
No Charge
Tier 1 in-network
No Charge
Out-of-network
50.00%
Limit: 2.0 Exam(s) per Year
See policy for other limits.
Exclusions: See policy for exclusions.
Major Dental Care - Adult
50.00% Coinsurance after deductible
Tier 1 in-network
50.00% Coinsurance after deductible
Out-of-network
50.00% Coinsurance after deductible
All dental services are subject to an annual maximum of $1,500. See policy for other limits. A 12-month exclusion period applies except if the member has one year of prior dental coverage with no more than a 90-day break in coverage from the end of the old plicy to the effective date of the new policy.
Exclusions: See policy for exclusions.
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
70.00% Coinsurance after deductible
Tier 1 in-network
70.00% Coinsurance after deductible
Out-of-network
70.00% Coinsurance after deductible
For medically necessary orthodontic treatment only.
Exclusions: See policy for exclusions.
Routine Dental Services (Adult)
No Charge
Tier 1 in-network
No Charge
Out-of-network
50.00%
Limit: 2.0 Exam(s) per Year
All dental services are subject to an annual maximum of $1,500. See policy for other limits.
Exclusions: See policy for exclusions.