Dental Plans

Good oral health is a key part of your overall health. Look over our dental plans below to find the plan with the preventive, basic, and major services that are right for you.

  • All prices and benefits listed are for each individual looking for a plan.
  • Benefits are for services received from participating providers.
  • Dollar amounts or percentages listed are the member’s out-of-pocket cost for adults (19 years and older).

Dental Plus Plan (for seniors 65 years and older)

Plan Deductible Calendar Year Maximum Out-of-Pocket Maximum Monthly Premiums
Adult

Plan Benefits

  (amount you pay)

Preventative

Exams: 0%

X-rays: 0%

Cleanings: 0%

Routine/Basic

Silver Fillings: 20%

White Fillings: 20%

Major

Crowns: 50%

Bridges: 50%

Dentures: 50%

Waiting period(s)

6 Month Routine/Basic
12 Month Major

All plan benefits shown are based on Eligible Charges. Services received from a non-participating provider will likely result in higher out-of-pocket expenses.

$251 $1,000 Does not apply $44.77/Single
$89.55/Two party

1. Deductible applies to basic and major services only.

Preferred Provider Organization Plans

Freedom to choose your own dentist.

Plan Deductible Calendar Year Maximum Out-of-Pocket Maximum Monthly Premiums
Essential
Pediatric

Plan Benefits

  (amount you pay)

Preventative

Exams: 0%

X-rays: 0%

Cleanings: 0%

Routine/Basic

Fillings: 30%

Periodontal: 30%

Root Canals: 30%

Major

Crowns: 50%

Bridges (adults only):
Not a Benefit

Dentures (complete/partial):
50%

Waiting period(s)

24 Month Medically Necessary Orthodontia

* Members ages 19-20 will be charged $39.37 but aren't eligible for plan benefits.

Pediatric benefits apply to members age 0-18.

$0 Does not apply $350 child/$700 (2+ children) max $39.37/Age 0 - 18
$39.37/Age 19 - 20*
$0/Age 21+
Basic
Pediatric

Plan Benefits

  (amount you pay)

Preventative

Exams: 10%

X-rays: 10%

Cleanings: 10%

Routine/Basic

Fillings: 40%

Periodontal: 40%

Root Canals: 40%

Major

Crowns: 60%

Bridges (adults only):
Not a Benefit

Dentures (complete/partial):
60%

Waiting period(s)

24 Month Medically Necessary Orthodontia

$25 Does not apply $350 child/$700 (2+ children) max $32.85/Age 0 - 18
Adult

Plan Benefits

  (amount you pay)

Preventative

Exams: 10%

X-rays: 10%

Cleanings: 10%

Routine/Basic

Fillings: 40%

Periodontal: Not a Benefit

Root Canals: Not a Benefit

Major

Crowns: Not a Benefit

Bridges (adults only):
Not a Benefit

Dentures (complete/partial):
Not a Benefit

Waiting period(s)

6 Month Basic

$25 $1,000 Does not apply $32.85/Age 19 - 20
$15.89/Age 21+
High
Pediatric

Plan Benefits

  (amount you pay)

Preventative

Exams: 0%

X-rays: 0%

Cleanings: 0%

Routine/Basic

Fillings: 30%

Periodontal: 30%

Root Canals: 30%

Major

Crowns: 50%

Bridges (adults only):
Not a Benefit

Dentures (complete/partial):
50%

Waiting period(s)

24 Month Medically Necessary Orthodontia

$0 Does not apply $350 child/$700 (2+ children) max $39.13/Age 0 - 18
Adult

Plan Benefits

  (amount you pay)

Preventative

Exams: 0%

X-rays: 0%

Cleanings: 0%

Routine/Basic

Fillings: 30%

Major

Crowns: 50%

Bridges (adults only): 50%

Dentures (complete/partial): 50%

Periodontal: 50%

Root Canals: 50%

Waiting period(s)

6 Month Basic

12 Month Major

$0 $1,000 Does not apply $39.13/Age 19 - 20
$32.91/Age 21+

Health Maintenance Organization Plans

See dentists in our HMO health center network.

Plan Deductible Calendar Year Maximum Out-of-Pocket Maximum Monthly Premiums
Basic
Pediatric

Plan Benefits

  (amount you pay)

Preventative

Exams: $10

X-rays: $10 & Up

Cleanings: $10

Routine/Basic

Fillings: $40 & Up

Periodontal: $20 & Up

Root Canals: $285

Major

Crowns: $225 & Up

Bridges (adults only):
Not a Benefit

Dentures (complete/partial):
$300

Waiting period(s)

24 Month Medically Necessary Orthodontia

$0 Does not apply $350 child/$700 (2+ children) max $21.39/Age 0 - 18
Adult

Plan Benefits

  (amount you pay)

Preventative

Exams: $10

X-rays: $10 & Up

Cleanings: $10

Routine/Basic

Fillings: $40 & Up

Periodontal: $20 & Up

Root Canals: $285

Major

Crowns: $225 & Up

Bridges (adults only):
$225 & Up

Dentures (complete/partial):
$300

Waiting period(s)

12 Month Major

$0 Does not apply Does not apply $21.39/Age 19 - 20 $20.35/Age 21+

2014 Dental Plus Plan (for seniors 65 years and older)

HMSA’s Dental Plus Plan offers you all the dental services you need at an affordable price.

Dental Plus for Seniors (amount you pay)

  • Deductible - $25*
  • Basic - 20%
  • Preventive - 0%
  • Major - 50%

* Deductible applies to Basic and Major services only.

Plan resources

Guide to Benefits
Dental Summary

Monthly Premium

Enroll by mail

2014

PPO Dental Plans

PPO members have the freedom to choose their own dentist from one of the largest network of providers in the state.

Basic Plan (amount you pay)

  • Deductible - $25
  • Basic - 40%
  • Preventive - 10%
  • Major - 100%

Plan resources

Guide to Benefits
Dental Summary

Monthly Premium

Get started Enroll by mail

High Plan (amount you pay)

  • Deductible - $0
  • Basic - 30%
  • Preventive - $0
  • Major - 50%

Plan resources

Guide to Benefits
Dental Summary

Monthly Premium

Get started Enroll by mail

HMO Dental Plan

Our HMO dental plan has the most value for members who want great care for the least amount of money. Services must be provided by Hawaii Family Dental Centers.

Basic Plan (amount you pay)

  • Deductible - $0
  • Basic - Copayment varies
  • Preventive - Copayment varies
  • Major - Copayment varies

Plan resources

Guide to Benefits
Dental Summary

Monthly Premium

Get started Enroll by mail