Benefits1
Coinsurance1
Plan pays:
In Network
100% Diagnostic & Preventive / 50% Basic / 15% Major (Year 1)
100% Diagnostic & Preventive / 60% Basic / 25% Major (Year 2)
100% Diagnostic & Preventive / 80% Basic / 50% Major (Year 3)
Out of Network
90% Diagnostic & Preventive / 30% Basic / 10% Major (Year 1)
90% Diagnostic & Preventive / 50% Basic / 20% Major (Year 2)
90% Diagnostic & Preventive / 70% Basic / 40% Major (Year 3)
Deductibles
$50 per adult (adult max $150)2
Annual Maximums
$1,000 per member
Waiting Periods
No waiting periods
Receive Care From
Elite PPO network dentist (DC, DE, MD, PA, VA), Choice PPO network dentist (FL, GA, IL, IN, MI, MO, NC, NJ, OR, WI) or any licensed dentist.
States Available
DC, DE, FL, GA3, IL, IN, MD, MI, MO, NC, NJ4, OR, PA, VA, WI
Diagnostic & Preventive Care1
Plan pays:
In Network
100% (Year 1)
100% (Year 2)
100% (Year 3)
Out of Network
90% (Year 1)
90% (Year 2)
90% (Year 3)
Services Include:
- Comprehensive Oral Exam
- Bitewing X-Rays (2 Sets)
- Teeth Cleanings (Adult)
Basic Services1
Plan pays:
In Network
50% (Year 1)
60% (Year 2)
80% (Year 3)
Out of Network
30% (Year 1)
50% (Year 2)
70% (Year 3)
Services Include
- Amalgam Filling (silver)
- Composite Filling (white)
- Extraction, Erupted Tooth
Major Services1
Plan pays:
In Network
15% (Year 1)
25% (Year 2)
50% (Year 3)
Out of Network
10% (Year 1)
20% (Year 2)
40% (Year 3)
Services Include:
- Crown (Porcelain/Metal)
- Bridges
- Complete Denture
- Relining of Dentures
- Periodontics (root planing and therapy)
- Endodontics (root canals)
- Oral Surgery (extraction of impacted teeth)
Orthodontics:
Orthodontia services are not covered
Choice PPO Basic Kids
Enrolled dependents under the age of 19 will automatically be enrolled in our pediatric dental plan.
Explore Everything Included in the Dental Plan
Prevention Rewards
Get Cleanings. Get Rewarded!
With our Prevention Rewards Program, primary subscribers receive $20 for themselves and each enrolled family member who completes two cleanings in a calendar year with a participating dentist. It's simple, rewarding and included in every dental plan.*Shop Plans* The Discount Program does not include Prevention Rewards. Please see plan documents for full terms and conditions.
Vision Plan
Complement your dental coverage with a vision benefit or enroll in just a vision plan.
Explore plans to see if a vision benefit is available in your area.
Shop Plans - Year 1 benefits apply during the subscriber's first 12 months of continuous coverage. Year 2 benefits apply during the subscriber's second 12 months of continuous coverage. Year 3 benefits apply during the subscriber's third 12 months of continuous coverage. Waiting period credit will be given for the length of time an insured was covered under each benefit classification under the current employer's prior dental coverage.
- Deductibles apply to all services.
- Plans in Georgia: Out of Network coinsurance is the same as the in-network coinsurance. Note when using an Out of Network provider, members may incur any charges exceeding the allowed amount.
- In New Jersey, Year 1 Major Restorative Care coinsurance is 30% in-network and 25% Out of Network. Year 2 Major Restorative Care coinsurance is 40% in-network and 30% Out of Network.
- Dominion National Internal Performance Report, 2024. Participating providers are subject to change.