Let Us Cover Your Smile

Plan Highlights

Benefits In Network Out of Network
Diagnostic & Preventative (No waiting period) 100% 100%
Exams & cleanings - Space maintainers
Bitewing x-rays - Sealants
Full Mouth x-ray - fluoride treatments
Basic Services (No waiting period)
Amalgam fillings - Basic extractions 80% 80%
Oral Surgery - Denture repairs
Endonotics - Bridge repair
Nonsurgical period - Surgical extractions
Major Services (12 month waiting period)
Surgical period - In/Onlays, Crowns 50% 50%
Dentures / Bridges
Orthodontic Services (12 month waiting period)
Dependant children under age 19 50% 50%
Per person/per family (calendar year) $50/$150 $50/$100
Applies to Basic and Major Services only
Annual Maximum per person (calendar year) $3,000 $3,000
Lifetime Ortho Maximums per person $3,000 $3,000
Claim Payments
Claim basis PPO Fee Schedule 90% of UCR

*See company brochure for more details. Plan not available in all states.

Contact us to request a quote and more information on how to enroll.