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 have to pay a deductible when you get your dental care out-of-network. It only applies to Class II and Class III services.

  • One member on the plan: $75 out of network
  • Two members: $150 out of network
  • Three or more members: $225 out of network

Dental benefits for children

Pediatric, or childrens' dental benefits, work differently than they do for adults. For example, there's no waiting period on services for children. 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 if there's one child on the plan
  • No more than $700 total for two or more children
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
All costs $0
Out of network
50% 50%
Class II
Restorative services, such as:
  • Fillings
  • Root canals
  • Other X-rays
In network
70% 30%, up to your out-of-pocket max
Out of network
50% 50%
Class III
Major restorative services, such as:
  • Crowns
  • Removal of wisdom teeth
  • Bridges and dentures
  • Major oral surgery
In network
50% 50%, up to your out-of-pocket max
Out of network
50% 50%

Dental benefits for adults

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

  • $1,200 for each adult for in-network dental care. Up to $800 of this total may be used toward out-of-network care.

There's also a waiting period for adults 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
All costs $0
Out of network
50% 50%
Class II

These services are covered six months after you first join this plan.
Restorative services such as:
  • Fillings
  • Root canals
  • Other X-rays
In network
70%, up to your benefit max
30%
Out of network
50% 50%
Class III

These services are covered 12 months after you first join this plan.
Major restorative services, such as:
  • Crowns
  • Removal of wisdom teeth
  • Bridges and dentures
  • Major oral surgery
In network
50%, up to your benefit max 50%
Out of network
50% 50%