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.

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 and out of network
100% 0%
Class II
Restorative services such as:
  • Fillings
  • Root canals
  • Other X-rays
In network
75% 25%, up to your out-of-pocket max
Out of network
75% 25%
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 begins 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. One you've reached that limit, you pay for all your dental care. This plan's benefit max is:

  • $1,500 total for each adult

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 and out of network
100%, up to your benefit max 0%, then all costs
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 and out of network
75%, up to your benefit max 25%, then all costs
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 and out of network
50%, up to your benefit max 50%, then all costs