Accidental Dental
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Basic Dental Care - Adult
$25.00
Tier 1 in-network
$25.00
Out-of-network
100.00%
Refer to plan summary for specific copay/cost-share information.
Dental Check-Up for Children
$5.00
Tier 1 in-network
$5.00
Out-of-network
100.00%
Limit: 2.0 Procedure(s) per Benefit Period
Routine cleaning, exams, x-rays, palliative, and fluoride. Sealants once every five years.\nRefer to plan summary for specific copay/cost-share information.
Major Dental Care - Adult
$371.00
Tier 1 in-network
$371.00
Out-of-network
100.00%
Refer to plan summary for specific copay/cost-share information.
Orthodontia - Adult
$3,250.00
Tier 1 in-network
$3,250.00
Out-of-network
100.00%
Refer to plan summary for specific copay/cost-share information.
Orthodontia - Child
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Routine Dental Services (Adult)
$5.00
Tier 1 in-network
$5.00
Out-of-network
100.00%
Refer to plan summary for specific copay/cost-share information.