Our Plans
We have a large variety of plans for you to choose from. Below you will find our most popular plan options.
Plan Benefit | PPO plus Premier 3 | PPO 3 | PPO plus Premier 5 |
---|---|---|---|
Preventative & Diagnostic | |||
Exams | 100% | 100% | 100% |
Cleanings | 100% | 100% | 100% |
Bitewing X-rays | 100% | 100% | 100% |
Full mouth X-Rays | 100% | 100% | 100% |
Topical Floride | 100% | 100% | 100% |
Space maintainers | 100% | 100% | 100% |
Basic Services | |||
Fillings | 80% | 80% | 100% |
Composite/resin restorations | 80% | 80% | 100% |
Sealants | 80% | 80% | 100% |
Simple Extractions | 80% | 80% | 100% |
Root Canal Therapy (Endodontics) | 80% | 80% | 100% |
Periodontal Maintenance | 80% | 80% | 100% |
Scaling and Root Planning | 80% | 80% | 100% |
Periodontal surgeries | 80% | 80% | 100% |
Oral Surgery | 80% | 80% | 100% |
General Anesthesia or IV sedation | 80% | 80% | 100% |
Major Services | |||
Single Crowns | 50% | 50% | 60% |
Stainless Steel Crowns | 50% | 50% | 60% |
Crown inlay, onlay and veneer repairs | 50% | 50% | 60% |
Crown recements | 50% | 50% | 60% |
Post and Core | 50% | 50% | 60% |
Inlays | 50% | 50% | 60% |
Inlays/Onlays | 50% | 50% | 60% |
Bridgework (abutment crowns and pontics) | 50% | 50% | 60% |
Recements | 50% | 50% | 60% |
Repairs | 50% | 50% | 60% |
Dentures(complete and partials) | 50% | 50% | 60% |
Adjustments | 50% | 50% | 60% |
Repairs, relines and rebases | 50% | 50% | 60% |
Dollar Maximum(per enrollee) | PPO - $1,500 Premier & Out-of-Network $1,000 |
$1,500 | PPO - $1,500 Premier & Out-of-Network $1,000 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
PPO - $50 Premier & Out-of-Network $150 |
PPO - $50 Premier & Out-of-Network $150 |
Orthodontics | Not Covered | Not Covered | Not Covered |
Plan Benefit | PPO plus Premier 3 |
---|---|
Preventative & Diagnostic | |
Exams | 100% |
Cleanings | 100% |
Bitewing X-rays | 100% |
Full mouth X-Rays | 100% |
Topical Floride | 100% |
Space maintainers | 100% |
Basic Services | |
Fillings | 80% |
Composite/resin restorations | 80% |
Sealants | 80% |
Simple Extractions | 80% |
Root Canal Therapy (Endodontics) | 80% |
Periodontal Maintenance | 80% |
Scaling and Root Planning | 80% |
Periodontal surgeries | 80% |
Oral Surgery | 80% |
General Anesthesia or IV sedation | 80% |
Major Services | |
Single Crowns | 50% |
Stainless Steel Crowns | 50% |
Crown inlay, onlay and veneer repairs | 50% |
Crown recements | 50% |
Post and Core | 50% |
Inlays | 50% |
Inlays/Onlays | 50% |
Bridgework (abutment crowns and pontics) | 50% |
Recements | 50% |
Repairs | 50% |
Dentures (complete and partials) | 50% |
Adjustments | 50% |
Repairs, relines and rebases | 50% |
Dollar Maximum(per enrollee) | PPO - $1,500 Premier & Out-of-Network $1,000 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
Orthadontics | Not Covered |
Plan Benefit | PPO 3 |
Preventative & Diagnostic | |
Exams | 100% |
Cleanings | 100% |
Bitewing X-rays | 100% |
Full mouth X-Rays | 100% |
Topical Floride | 100% |
Space maintainers | 100% |
Basic Services | |
Fillings | 80% |
Composite/resin restorations | 80% |
Sealants | 80% |
Simple Extractions | 80% |
Root Canal Therapy (Endodontics) | 80% |
Periodontal Maintenance | 80% |
Scaling and Root Planning | 80% |
Periodontal surgeries | 80% |
Oral Surgery | 80% |
General Anesthesia or IV sedation | 80% |
Major Services | |
Single Crowns | 50% |
Stainless Steel Crowns | 50% |
Crown inlay, onlay and veneer repairs | 50% |
Crown recements | 50% |
Post and Core | 50% |
Inlays | 50% |
Inlays/Onlays | 50% |
Bridgework (abutment crowns and pontics) | 50% |
Recements | 50% |
Repairs | 50% |
Dentures (complete and partials) | 50% |
Adjustments | 50% |
Repairs, relines and rebases | 50% |
Dollar Maximum(per enrollee) | $1,500 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
Orthadontics | Not Covered |
Plan Benefit | PPO plus Premier 5 |
Preventative & Diagnostic | |
Exams | 100% |
Cleanings | 100% |
Bitewing X-rays | 100% |
Full mouth X-Rays | 100% |
Topical Floride | 100% |
Space maintainers | 100% |
Basic Services | |
Fillings | 100% |
Composite/resin restorations | 100% |
Sealants | 100% |
Simple Extractions | 100% |
Root Canal Therapy (Endodontics) | 100% |
Periodontal Maintenance | 100% |
Scaling and Root Planning | 100% |
Periodontal surgeries | 100% |
Oral Surgery | 100% |
General Anesthesia or IV sedation | 100% |
Major Services | |
Single Crowns | 60% |
Stainless Steel Crowns | 60% |
Crown inlay, onlay and veneer repairs | 60% |
Crown recements | 60% |
Post and Core | 60% |
Inlays | 60% |
Inlays/Onlays | 60% |
Bridgework (abutment crowns and pontics) | 60% |
Recements | 60% |
Repairs | 60% |
Dentures (complete and partials) | 60% |
Adjustments | 60% |
Repairs, relines and rebases | 60% |
Dollar Maximum(per enrollee) | PPO - $1,500 Premier & Out-of-Network $1,000 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
Orthadontics | Not Covered |
Plan Benefit | PPO plus Premier 3 | PPO 3 | PPO 2 |
---|---|---|---|
Preventative & Diagnostic | |||
Exams | 100% | 100% | 100% |
Cleanings | 100% | 100% | 100% |
Bitewing X-rays | 100% | 100% | 100% |
Full mouth X-rays | 100% | 100% | 100% |
Topical Floride | 100% | 100% | 100% |
Sealants | 100% | 100% | 100% |
Space maintainers | 100% | 100% | 100% |
Basic Services | |||
Fillings | 80% | 80% | 100% |
Composite/resin restorations | 80% | 80% | 100% |
Simple Extractions | 80% | 80% | 100% |
Root Canal Therapy (Endodontics) | 80% | 80% | 100% |
Periodontal Maintenance | 80% | 80% | 100% |
Scaling and Root Planning | 80% | 80% | 100% |
Periodontal surgeries | 80% | 80% | 100% |
Oral Surgery | 80% | 80% | 100% |
General Anesthesia or IV sedation | 80% | 80% | 100% |
Major Services | |||
Single Crowns | 50% | 50% | 60% |
Stainless Steel Crowns | 50% | 50% | 60% |
Crown inlay, onlay and veneer repairs | 50% | 50% | 60% |
Crown recements | 50% | 50% | 60% |
Post and Core | 50% | 50% | 60% |
Implants | 50% | 50% | 60% |
Inlays | 50% | 50% | 60% |
Inlays/Onlays | 50% | 50% | 60% |
Bridgework (abutment crowns and pontics) | 50% | 50% | 60% |
Recements | 50% | 50% | 60% |
Repairs | 50% | 50% | 60% |
Dentures (complete and partials) | 50% | 50% | 60% |
Adjustments | 50% | 50% | 60% |
Repairs, relines and rebases | 50% | 50% | 60% |
Dollar Maximum(per enrollee) | PPO - $1,500 Premier & Out-of-Network $1,000 |
$1,500 | PPO - $1,500 Premier & Out-of-Network $1,000 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
PPO - $50 Premier & Out-of-Network $150 |
PPO - $50 Premier & Out-of-Network $150 |
Orthodontics | Not Covered | Not Covered | Not Covered |
Plan Benefit | PPO plus Premier 3 |
---|---|
Preventative & Diagnostic | |
Exams | 100% |
Cleanings | 100% |
Bitewing X-rays | 100% |
Full Mouth X-rays | 100% |
Topical Floride | 100% |
Sealants | 100% |
Space maintainers | 100% |
Basic Services | |
Fillings | 80% |
Composite/resin restorations | 80% |
Simple Extractions | 80% |
Root Canal Therapy (Endodontics) | 80% |
Periodontal Maintenance | 80% |
Scaling and Root Planning | 80% |
Periodontal surgeries | 80% |
Oral Surgery | 80% |
General Anesthesia or IV sedation | 80% |
Major Services | |
Single Crowns | 50% |
Stainless Steel Crowns | 50% |
Crown inlay, onlay and veneer repairs | 50% |
Crown recements | 50% |
Post and Core | 50% |
Implants | 50% |
Inlays | 50% |
Inlays/Onlays | 50% |
Bridgework (abutment crowns and pontics) | 50% |
Recements | 50% |
Repairs | 50% |
Dentures (complete and partials) | 50% |
Adjustments | 50% |
Repairs, relines and rebases | 50% |
Dollar Maximum(per enrollee) | PPO - $1,500 Premier & Out-of-Network $1,000 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
Orthodontics | Not Covered |
Plan Benefit | PPO 3 |
Preventative & Diagnostic | |
Exams | 100% |
Cleanings | 100% |
Bitewing X-rays | 100% |
Full Mouth X-rays | 100% |
Topical Floride | 100% |
Sealants | 100% |
Space maintainers | 100% |
Basic Services | |
Fillings | 80% |
Composite/resin restorations | 80% |
Simple Extractions | 80% |
Root Canal Therapy (Endodontics) | 80% |
Periodontal Maintenance | 80% |
Scaling and Root Planning | 80% |
Periodontal surgeries | 80% |
Oral Surgery | 80% |
General Anesthesia or IV sedation | 80% |
Major Services | |
Single Crowns | 50% |
Stainless Steel Crowns | 50% |
Crown inlay, onlay and veneer repairs | 50% |
Crown recements | 50% |
Post and Core | 50% |
Implants | 50% |
Inlays | 50% |
Inlays/Onlays | 50% |
Bridgework (abutment crowns and pontics) | 50% |
Recements | 50% |
Repairs | 50% |
Dentures (complete and partials) | 50% |
Adjustments | 50% |
Repairs, relines and rebases | 50% |
Dollar Maximum(per enrollee) | $1,500 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
Orthodontics | Not Covered |
Plan Benefit | PPO 2 |
Preventative & Diagnostic | |
Exams | 100% |
Cleanings | 100% |
Bitewing X-rays | 100% |
Full Mouth X-rays | 100% |
Topical Floride | 100% |
Sealants | 100% |
Space maintainers | 100% |
Basic Services | |
Fillings | 100% |
Composite/resin restorations | 100% |
Simple Extractions | 100% |
Root Canal Therapy (Endodontics) | 100% |
Periodontal Maintenance | 100% |
Scaling and Root Planning | 100% |
Periodontal surgeries | 100% |
Oral Surgery | 100% |
General Anesthesia or IV sedation | 100% |
Major Services | |
Single Crowns | 60% |
Stainless Steel Crowns | 60% |
Crown inlay, onlay and veneer repairs | 60% |
Crown recements | 60% |
Post and Core | 60% |
Implants | 60% |
Inlays | 60% |
Inlays/Onlays | 60% |
Bridgework (abutment crowns and pontics) | 60% |
Recements | 60% |
Repairs | 60% |
Dentures (complete and partials) | 60% |
Adjustments | 60% |
Repairs, relines and rebases | 60% |
Dollar Maximum(per enrollee) | PPO - $1,500 Premier & Out-of-Network $1,000 |
Deductible(per person/per family - excluding Preventive and Diagnostic) | PPO - $50 Premier & Out-of-Network $150 |
Orthodontics | Not Covered |