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
Dental Check-Up for Children
0.00%
Tier 1 in-network
0.00%
Out-of-network
0.00%
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
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
50.00% Coinsurance after deductible
Tier 1 in-network
50.00% Coinsurance after deductible
Out-of-network
50.00% Coinsurance after deductible
Orthodontic services require prior authorization and are only covered for eligible children with cases of severe orthodontic abnormality caused by genetic deformity (such as cleft lip or cleft palate) or traumatic facial injury resulting in serious health impairment to the beneficiary at the present time.
Routine Dental Services (Adult)
0.00%
Tier 1 in-network
0.00%
Out-of-network
10.00%