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You can get more details about what this plan covers in this brochure (PDF).

In-network dental benefits

When you go to a dentist in the preferred network, that's called getting your care in-network. Find a dentist.

This plan doesn't cover any out-of-network dental care. You'll pay all costs if you go to a dentist who isn't in the preferred network.

Your deductible

You pay one deductible for Class II and Class III dental services.

  • One member on the plan: $25
  • Two members: $50
  • Three or more members: $75

Dental benefits for pediatric members

Dental benefits for pediatric members work differently than they do for adults. For example, there's no waiting period on services. And when you see a dentist in the preferred network, there's a limit on your share of the costs. That's called an out-of-pocket max. Children can get pediatric dental benefits until the end of the calendar year in which they turn 19. In a year, you pay:

  • No more than $350 total for one pediatric member
  • No more than $700 total for two or more pediatric members
What we call it What it is When you pay
What you pay
Class I

Preventive services like:

  • Exams
  • Cleaning
  • Bitewing X-rays
Before out-of-pocket max
20%
After out-of-pocket max $0
Class II
Minor restorative services like:
  • Fillings
  • Root canal treatment
  • Other X-rays
Before out-of-pocket max Your deductible then 50%
After out-of-pocket max $0
Class III
Major restorative services like:
  • Crowns
  • Oral surgery
  • Gum surgery
Before out-of-pocket max Your deductible then 50%
After out-of-pocket max $0

Dental benefits for adults

There's a limit on what your plan pays for nonpediatric benefits: dental care for members who are 19 or older when their plan starts. It's called an annual benefit maximum. Once you've reached that limit for the year, you pay for all your dental care. This plan's benefit max is:

  • $1,200 total for each adult

There's also a waiting period for Class II and Class III services. We've listed them below.

What we call it What it is When you pay What you pay
Class I

Preventive services like:

  • Exams
  • Cleaning
  • Bitewing X-rays
Before benefit max 20%
After benefit max All costs
Class II

These services are covered six months after you first join a Blue Dental plan.
Minor restorative services like:
  • Fillings
  • Root canal treatment
  • Other X-rays
Before benefit max
Your deductible then 50%
After benefit max All costs
Class III

These services are covered 12 months after you first join a Blue Dental plan.
Major restorative services like:
  • Crowns
  • Bridges and dentures
  • Oral and gum surgery
Before benefit max
Your deductible then 50%
After benefit max All costs