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 |