Accidental Dental
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Basic Dental Care - Adult
40.00% Coinsurance after deductible
Tier 1 in-network
40.00% Coinsurance after deductible
Out-of-network
60.00% Coinsurance after deductible
An annual deductible and maximum apply to adult services. A 6-month waiting period applies to Basic Dental Care for adults.
Dental Check-Up for Children
No Charge after deductible
Tier 1 in-network
No Charge after deductible
Out-of-network
No Charge after deductible
Major Dental Care - Adult
50.00% Coinsurance after deductible
Tier 1 in-network
50.00% Coinsurance after deductible
Out-of-network
70.00% Coinsurance after deductible
An annual deductible and maximum apply to adult services. A 12-month waiting period applies to Major Dental Care for adults.
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
50.00%
Tier 1 in-network
50.00%
Out-of-network
100.00%
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)
No Charge after deductible
Tier 1 in-network
No Charge after deductible
Out-of-network
30.00% Coinsurance after deductible
An annual deductible and maximum apply to adult services.