What You’ll Pay For Your Dental Care
Select a type of plan to find out how much you’ll pay.
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$50 Deductible for Adults
$75 for Children
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No Annual Benefit Limit for Children
$1,500 Annual Benefit Limit for Adults
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$350
Individual Out-of-Pocket Maximum (child only)
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$700
Family Out-of-Pocket Maximum (two or more children only)
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$0
Office Copay
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Six-Month Waiting Period
For Major Services for Adults
Services
| Service | Price |
|---|---|
| Diagnostic and Preventive (includes x-rays, exams, cleaning and sealants) | Free |
| Amalgam Filling: One Surface | Pay 20% of bill |
| Root Canal: Molar | Pay 50% of bill |
| Gingivectomy, Per Tooth | Pay 50% of bill |
| Extraction: Single Tooth, Exposed Root or Erupted | Pay 50% of bill |
| Extraction: Complete Bony | Pay 50% of bill |
| Crown: Porcelain With Metal | Pay 50% of bill |
| Medically Necessary Orthodontia | Children – pay 50% of bill Not Covered for Adults |
Ready to care for your health?
Need help applying?
You can get help from a certified enrollment counselor right away. It’s always free and confidential. Talk to someone about your options and have them guide you through the process. You can enroll in person, by phone or online.
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