Tier 1 in-network
0.00%
Out-of-network
20.00%
Exclusions: See Plan Brochure.
Basic Dental Care - Adult
25.00% Coinsurance after deductible
Tier 1 in-network
25.00% Coinsurance after deductible
Out-of-network
40.00% Coinsurance after deductible
Exclusions: These services may be subject to a waiting period. See Plan Brochure for additional information.
Dental Check-Up for Children
0.00%
Tier 1 in-network
0.00%
Out-of-network
20.00%
Limit: 2.0 Visit(s) per Benefit Period
Exclusions: See Plan Brochure. X-Rays may be subject to deductible.
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
Exclusions: These services may be subject to a waiting period. See Plan Brochure for additional information.
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
50.00%
Exclusions: Limited to medically necessary. See Plan Brochure.
Routine Dental Services (Adult)
0.00%
Tier 1 in-network
0.00%
Out-of-network
20.00%
Limit: 2.0 Visit(s) per Benefit Period
Exclusions: See Plan Brochure. X-Rays may be subject to deductible.