Accidental Dental
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Basic Dental Care - Adult
No Charge after deductible, 20.00% Coinsurance after deductible
Tier 1 in-network
No Charge after deductible, 20.00% Coinsurance after deductible
Out-of-network
No Charge after deductible, 20.00% Coinsurance after deductible
Deductible applies. For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.
Exclusions: Deductible applies. For covered persons over the age 18 there is a 6 month waiting period on Class II - Basic services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.
Dental Check-Up for Children
No Charge, No Charge
Tier 1 in-network
No Charge, No Charge
Out-of-network
No Charge, No Charge
Limit: 1.0 Visit(s) per 6 Months
MOOP only applies to covered persons through the end of the month in which they turn 19.
Exclusions: MOOP only applies to covered persons through the end of the month in which they turn 19.
Major Dental Care - Adult
No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network
No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network
No Charge after deductible, 50.00% Coinsurance after deductible
Deductible applies. For covered persons over the age 18 there is a 12 month waiting period on Class III - Major services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.
Exclusions: Deductible applies. For covered persons over the age 18 there is a 12 month waiting period on Class III - Major services. Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
No Charge, 50.00%
Tier 1 in-network
No Charge, 50.00%
Out-of-network
No Charge, 50.00%
Applies to medically necessary procedures only. MOOP only applies to covered persons through the end of the month in which they turn 19.
Exclusions: Applies to medically necessary procedures only. MOOP only applies to covered persons through the end of the month in which they turn 19.
Routine Dental Services (Adult)
No Charge, No Charge
Tier 1 in-network
No Charge, No Charge
Out-of-network
No Charge, No Charge
Limit: 1.0 Visit(s) per 6 Months
Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.
Exclusions: Applies to a $1500 annual maximum. MOOP only applies to covered persons through the end of the month in which they turn 19.