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

In- and out-of-network dental benefits

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

Because this plan is a PPO, it shares the cost if you go to a dentist that isn't in the preferred network. That's called getting your care out of network. You'll save money if you use a preferred network dentist.

Your deductible

You only pay a deductible for Class II and Class III dental services if you see a dentist that isn't in the preferred network.

  • One member on the plan: $50 out of network
  • Two members: $100 out of network
  • Three or more members: $150 out of network

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
In network
Before or after
out-of-pocket max
$0
Out of network
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


In network
Before out-of-pocket max 30%
After out-of-pocket max $0
Out of network
Any time Your deductible, then 40%
Class III

Major restorative services like:

  • Crowns
  • Oral surgery
  • Gum surgery


In network
Before out-of-pocket max 50%
After out-of-pocket max $0
Out of network
Any time Your deductible, then 50%

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 for each adult for in-network care. Up to $1,000 of this total may be used toward out-of-network care.

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 What plan pays What you pay
Class I

Preventive services like:

  • Exams
  • Cleaning
  • Bitewing X-rays
In network
Before benefit max $0
After benefit max All costs
Out of network
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


In network
Before benefit max 30%
After benefit max All costs
Out of network
Before benefit max Your deductible, then 40%
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


In network
Before benefit max 50%
After benefit max All costs
Out of network
Before benefit max Your deductible, then 50%
After benefit max All costs