2025 Plans
Preferred Provider Plans
Get the freedom to choose your own dentist. See a PPO Dental Network for lower out-of-pocket costs.
| Plan | wcag | Deductible | Calendar year maximum | Max out-of-pocket | Monthly premiums |
|---|---|---|---|---|---|
| Essential | |||||
| Pediatric |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorSimple and Surgical Extractions: 50% Crowns: 50% Metal Noble Crowns Plan Resources |
$0 | None | $400 child / $800 (2+ children) max | $36.65 / ages 0 - 18 |
| PPO Bronze 1000 | |||||
| Pediatric |
Plan Benefits(amount you pay) PreventativeExams: 10% X-rays: 10% Cleanings: 10% Fluoride: 10% Routine/BasicFillings: 40% Periodontal: 40% Scaling and Root Planing Root Canals: 40% Simple Extractions: 40% MajorCrowns: 60% Metal Noble Crowns Surgical Extractions: 60% Plan Resources |
$25 Applies to all categories | None | $400 child / $800 (2+ children) max | $30.93 / ages 0 - 18 |
| Adult |
Plan Benefits(amount you pay) PreventativeExams: 10% X-rays: 10% Cleanings: 10% Routine/BasicFillings: 40% Periodontal: Not covered Root Canals: Not covered Simple Extractions: 40% MajorCrowns: Not covered Surgical Extractions: Not covered Waiting period(s)6 Months for Basic Care Plan Resources |
$25 Applies to all categories | $1,000 | Not applicable | $14.66 / age 19+ |
| PPO Platinum 1000 | |||||
| Pediatric |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorSimple and Surgical Extractions: 30% Crowns: 30% Metal Noble Crowns Plan Resources |
$0 | None | $400 child / $800 (2+ children) max | $39.20 / ages 0 - 18 |
| Adult |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Routine/BasicFillings: 30% MajorCrowns: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% Simple and Surgical Extractions: 30% Waiting period(s)12 Months for Major Care Plan Resources |
$0 | $1,000 | Not applicable | $36.50 / age 19+ |
| PPO Gold 1500 | |||||
| Pediatric |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorCrowns: 50% Metal Noble Crowns Simple and Surgical Extractions: 50% Plan Resources |
$0 | None | $400 child / $800 (2+ children) max | $37.73 / ages 0 - 18 |
| Adult |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Routine/BasicFillings: 30% MajorCrowns: 50% Periodontal: 50% Scaling and Root Planing Root Canals: 50% Simple and Surgical Extractions: 50% Waiting period(s)12 Months for Major Care Plan Resources |
$0 | $1,500 | Not applicable | $34.74 / age 19+ |
| PPO Platinum 1500 Plus | |||||
| Pediatric |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorCrowns: 30% Metal Noble Crowns Simple and Surgical Extractions: 30% Orthodontics: 100% up to lifetime maximum of $1,000 Plan Resources |
$0 | None | $400 child / $800 (2+ children) max | $40.16 / ages 0 - 18 |
| Adult |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Routine/BasicFillings: 30% MajorCrowns: 30% Periodontal: 30% Root Canals: 30% Simple and Surgical Extractions: 30% Waiting period(s)12 Months for Major Care Plan Resources |
$0 | $1,500 | Not applicable | $42.30 / age 19+ |
Health Maintenance Organization Plans
See dentists in our HMO Dental Network.
| Plan | wcag | Deductible | Calendar year maximum | Max out-of-pocket | Monthly premiums |
|---|---|---|---|---|---|
| HMO Silver | |||||
| Pediatric |
Plan Benefits(amount you pay) PreventativeExams: $10 X-rays: $5 & Up Cleanings: $10 Fluoride: $5 Routine/BasicFillings: $40 & Up Periodontal: $90 & Up Scaling and Root Planing Root Canals: $285 and Up MajorCrowns: $250 & Up Metal Noble Crown Plan Resources |
$0 | None | $400 child / $800 (2+ children) max | $20.21 / ages 0 - 18 |
| Adult |
Plan Benefits(amount you pay) PreventativeExams: $10 X-rays: $5 & Up Cleanings: $10 Routine/BasicFillings: $40 & Up MajorPeriodontal: $90 & Up Scaling and Root Planing Root Canals: $285 and Up Crowns: $225 & Up Waiting period(s)12 Months for Major Care Plan Resources |
$0 | None | Not applicable | $17.73 / age 19+ |
| HMO Gold | |||||
| Pediatric |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $10 Fluoride: $0 Routine/BasicFillings: $35 & Up Periodontal: $50 & Up Scaling and Root Planing Root Canals: $50 & Up MajorCrowns: $100 Metal Noble Crowns Plan Resources |
$0 | None | $400 child / $800 (2+ children) max | $25.54 / ages 0 - 18 |
| Adult |
Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $10 Routine/BasicFillings: $35 & Up MajorPeriodontal: $50 & Up Root Canals: $50 & Up Crowns: $100 & Up Waiting period(s)12 Months for Major Care Plan Resources |
$0 | None | Not applicable | $27.24 / age 19+ |
2024 Plans
Preferred Provider Plans
Get the freedom to choose your own dentist. See a PPO Dental Network for lower out-of-pocket costs.
| Plan | wcag | Deductible | Calendar year maximum | Max out-of-pocket | Monthly premiums |
|---|---|---|---|---|---|
| Essential | |||||
| Pediatric | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorSimple and Surgical Extractions: 50% Crowns: 50% Metal Noble Crowns | $0 | None | $400 child / $800 (2+ children) max | $36.65 / ages 0 - 18 |
| PPO Bronze 1000 | |||||
| Pediatric | Plan Benefits(amount you pay) PreventativeExams: 10% X-rays: 10% Cleanings: 10% Fluoride: 10% Routine/BasicFillings: 40% Periodontal: 40% Scaling and Root Planing Root Canals: 40% Simple Extractions: 40% MajorCrowns: 60% Metal Noble Crowns Surgical Extractions: 60% | $25 Applies to all categories | None | $400 child / $800 (2+ children) max | $30.93 / ages 0 - 18 |
| Adult | Plan Benefits(amount you pay) PreventativeExams: 10% X-rays: 10% Cleanings: 10% Routine/BasicFillings: 40% Periodontal: Not covered Root Canals: Not covered Simple Extractions: 40% MajorCrowns: Not covered Surgical Extractions: Not covered Waiting period(s)6 Months for Basic Care | $25 Applies to all categories | $1,000 | Not applicable | $14.66 / age 19+ |
| PPO Platinum 1000 | |||||
| Pediatric | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorSimple and Surgical Extractions: 30% Crowns: 30% Metal Noble Crowns | $0 | None | $400 child / $800 (2+ children) max | $39.20 / ages 0 - 18 |
| Adult | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Routine/BasicFillings: 30% MajorCrowns: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% Simple and Surgical Extractions: 30% Waiting period(s)12 Months for Major Care | $0 | $1,000 | Not applicable | $36.50 / age 19+ |
| PPO Gold 1500 | |||||
| Pediatric | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorCrowns: 50% Metal Noble Crowns Simple and Surgical Extractions: 50% | $0 | None | $400 child / $800 (2+ children) max | $37.73 / ages 0 - 18 |
| Adult | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Routine/BasicFillings: 30% MajorCrowns: 50% Periodontal: 50% Scaling and Root Planing Root Canals: 50% Simple and Surgical Extractions: 50% Waiting period(s)12 Months for Major Care | $0 | $1,500 | Not applicable | $34.74 / age 19+ |
| PPO Platinum 1500 Plus | |||||
| Pediatric | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Fluoride: $0 Routine/BasicFillings: 30% Periodontal: 30% Scaling and Root Planing Root Canals: 30% MajorCrowns: 30% Metal Noble Crowns Simple and Surgical Extractions: 30% Orthodontics: 100% up to lifetime maximum of $1,000 | $0 | None | $400 child / $800 (2+ children) max | $40.16 / ages 0 - 18 |
| Adult | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $0 Routine/BasicFillings: 30% MajorCrowns: 30% Periodontal: 30% Root Canals: 30% Simple and Surgical Extractions: 30% Waiting period(s)12 Months for Major Care | $0 | $1,500 | Not applicable | $42.30 / age 19+ |
Health Maintenance Organization Plans
See dentists in our HMO Dental Network.
| Plan | wcag | Deductible | Calendar year maximum | Max out-of-pocket | Monthly premiums |
|---|---|---|---|---|---|
| HMO Silver | |||||
| Pediatric | Plan Benefits(amount you pay) PreventativeExams: $10 X-rays: $5 & Up Cleanings: $10 Fluoride: $5 Routine/BasicFillings: $40 & Up Periodontal: $90 & Up Scaling and Root Planing Root Canals: $285 and Up MajorCrowns: $250 & Up Metal Noble Crown | $0 | None | $400 child / $800 (2+ children) max | $20.21 / ages 0 - 18 |
| Adult | Plan Benefits(amount you pay) PreventativeExams: $10 X-rays: $5 & Up Cleanings: $10 Routine/BasicFillings: $40 & Up MajorPeriodontal: $90 & Up Scaling and Root Planing Root Canals: $285 and Up Crowns: $225 & Up Waiting period(s)12 Months for Major Care | $0 | None | Not applicable | $17.73 / age 19+ |
| HMO Gold | |||||
| Pediatric | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $10 Fluoride: $0 Routine/BasicFillings: $35 & Up Periodontal: $50 & Up Scaling and Root Planing Root Canals: $50 & Up MajorCrowns: $100 Metal Noble Crowns | $0 | None | $400 child / $800 (2+ children) max | $25.54 / ages 0 - 18 |
| Adult | Plan Benefits(amount you pay) PreventativeExams: $0 X-rays: $0 Cleanings: $10 Routine/BasicFillings: $35 & Up MajorPeriodontal: $50 & Up Root Canals: $50 & Up Crowns: $100 & Up Waiting period(s)12 Months for Major Care | $0 | None | Not applicable | $27.24 / age 19+ |