Our Plans

We have a large variety of plans for you to choose from. Below you will find our most popular plan options.

Plan Benefit PPO plus Premier 3 PPO 3 PPO plus Premier 5
Preventative & Diagnostic      
Exams 100% 100% 100%
Cleanings 100% 100% 100%
Bitewing X-rays 100% 100% 100%
Full mouth X-Rays 100% 100% 100%
Topical Floride 100% 100% 100%
Space maintainers 100% 100% 100%
Basic Services      
Fillings 80% 80% 100%
Composite/resin restorations 80% 80% 100%
Sealants 80% 80% 100%
Simple Extractions 80% 80% 100%
Root Canal Therapy (Endodontics) 80% 80% 100%
Periodontal Maintenance 80% 80% 100%
Scaling and Root Planning 80% 80% 100%
Periodontal surgeries 80% 80% 100%
Oral Surgery 80% 80% 100%
General Anesthesia or IV sedation 80% 80% 100%
Major Services      
Single Crowns 50% 50% 60%
Stainless Steel Crowns 50% 50% 60%
Crown inlay, onlay and veneer repairs 50% 50% 60%
Crown recements 50% 50% 60%
Post and Core 50% 50% 60%
Inlays 50% 50% 60%
Inlays/Onlays 50% 50% 60%
Bridgework (abutment crowns and pontics) 50% 50% 60%
Recements 50% 50% 60%
Repairs 50% 50% 60%
Dentures(complete and partials) 50% 50% 60%
Adjustments 50% 50% 60%
Repairs, relines and rebases 50% 50% 60%
       
Dollar Maximum(per enrollee) PPO - $1,500
Premier & Out-of-Network $1,000
$1,500 PPO - $1,500
Premier & Out-of-Network $1,000
Deductible(per person/per family - excluding Preventive and Diagnostic) PPO - $50
Premier & Out-of-Network $150
PPO - $50
Premier & Out-of-Network $150
PPO - $50
Premier & Out-of-Network $150
Orthodontics Not Covered Not Covered Not Covered
Plan BenefitPPO plus Premier 3
Preventative & Diagnostic 
Exams100%
Cleanings100%
Bitewing X-rays100%
Full mouth X-Rays100%
Topical Floride100%
Space maintainers100%
Basic Services 
Fillings80%
Composite/resin restorations80%
Sealants80%
Simple Extractions80%
Root Canal Therapy (Endodontics)80%
Periodontal Maintenance80%
Scaling and Root Planning80%
Periodontal surgeries80%
Oral Surgery80%
General Anesthesia or IV sedation80%
Major Services 
Single Crowns50%
Stainless Steel Crowns50%
Crown inlay, onlay and veneer repairs50%
Crown recements50%
Post and Core50%
Inlays50%
Inlays/Onlays50%
Bridgework (abutment crowns and pontics)50%
Recements50%
Repairs50%
Dentures (complete and partials)50%
Adjustments50%
Repairs, relines and rebases50%
  
Dollar Maximum(per enrollee)PPO - $1,500 Premier & Out-of-Network $1,000
Deductible(per person/per family - excluding Preventive and Diagnostic)PPO - $50
Premier & Out-of-Network $150
OrthadonticsNot Covered
  
Plan BenefitPPO 3
Preventative & Diagnostic 
Exams100%
Cleanings100%
Bitewing X-rays100%
Full mouth X-Rays100%
Topical Floride100%
Space maintainers100%
Basic Services 
Fillings80%
Composite/resin restorations80%
Sealants80%
Simple Extractions80%
Root Canal Therapy (Endodontics)80%
Periodontal Maintenance80%
Scaling and Root Planning80%
Periodontal surgeries80%
Oral Surgery80%
General Anesthesia or IV sedation80%
Major Services 
Single Crowns50%
Stainless Steel Crowns50%
Crown inlay, onlay and veneer repairs50%
Crown recements50%
Post and Core50%
Inlays50%
Inlays/Onlays50%
Bridgework (abutment crowns and pontics)50%
Recements50%
Repairs50%
Dentures (complete and partials)50%
Adjustments50%
Repairs, relines and rebases50%
  
Dollar Maximum(per enrollee)$1,500
Deductible(per person/per family - excluding Preventive and Diagnostic)PPO - $50
Premier & Out-of-Network $150
OrthadonticsNot Covered
  
Plan BenefitPPO plus Premier 5
Preventative & Diagnostic 
Exams100%
Cleanings100%
Bitewing X-rays100%
Full mouth X-Rays100%
Topical Floride100%
Space maintainers100%
Basic Services 
Fillings100%
Composite/resin restorations100%
Sealants100%
Simple Extractions100%
Root Canal Therapy (Endodontics)100%
Periodontal Maintenance100%
Scaling and Root Planning100%
Periodontal surgeries100%
Oral Surgery100%
General Anesthesia or IV sedation100%
Major Services 
Single Crowns60%
Stainless Steel Crowns60%
Crown inlay, onlay and veneer repairs60%
Crown recements60%
Post and Core60%
Inlays60%
Inlays/Onlays60%
Bridgework (abutment crowns and pontics)60%
Recements60%
Repairs60%
Dentures (complete and partials)60%
Adjustments60%
Repairs, relines and rebases60%
  
Dollar Maximum(per enrollee)PPO - $1,500 Premier & Out-of-Network $1,000
Deductible(per person/per family - excluding Preventive and Diagnostic)PPO - $50
Premier & Out-of-Network $150
OrthadonticsNot Covered
Plan Benefit PPO plus Premier 3 PPO 3 PPO 2
Preventative & Diagnostic      
Exams 100% 100% 100%
Cleanings 100% 100% 100%
Bitewing X-rays 100% 100% 100%
Full mouth X-rays 100% 100% 100%
Topical Floride 100% 100% 100%
Sealants 100% 100% 100%
Space maintainers 100% 100% 100%
Basic Services      
Fillings 80% 80% 100%
Composite/resin restorations 80% 80% 100%
Simple Extractions 80% 80% 100%
Root Canal Therapy (Endodontics) 80% 80% 100%
Periodontal Maintenance 80% 80% 100%
Scaling and Root Planning 80% 80% 100%
Periodontal surgeries 80% 80% 100%
Oral Surgery 80% 80% 100%
General Anesthesia or IV sedation 80% 80% 100%
Major Services      
Single Crowns 50% 50% 60%
Stainless Steel Crowns 50% 50% 60%
Crown inlay, onlay and veneer repairs 50% 50% 60%
Crown recements 50% 50% 60%
Post and Core 50% 50% 60%
Implants 50% 50% 60%
Inlays 50% 50% 60%
Inlays/Onlays 50% 50% 60%
Bridgework (abutment crowns and pontics) 50% 50% 60%
Recements 50% 50% 60%
Repairs 50% 50% 60%
Dentures (complete and partials) 50% 50% 60%
Adjustments 50% 50% 60%
Repairs, relines and rebases 50% 50% 60%
       
Dollar Maximum(per enrollee) PPO - $1,500
Premier & Out-of-Network $1,000
$1,500 PPO - $1,500
Premier & Out-of-Network $1,000
Deductible(per person/per family - excluding Preventive and Diagnostic) PPO - $50
Premier & Out-of-Network $150
PPO - $50
Premier & Out-of-Network $150
PPO - $50
Premier & Out-of-Network $150
Orthodontics Not Covered Not Covered Not Covered
Plan BenefitPPO plus Premier 3
Preventative & Diagnostic 
Exams100%
Cleanings100%
Bitewing X-rays100%
Full Mouth X-rays100%
Topical Floride100%
Sealants100%
Space maintainers100%
Basic Services 
Fillings80%
Composite/resin restorations80%
Simple Extractions80%
Root Canal Therapy (Endodontics)80%
Periodontal Maintenance80%
Scaling and Root Planning80%
Periodontal surgeries80%
Oral Surgery80%
General Anesthesia or IV sedation80%
Major Services 
Single Crowns50%
Stainless Steel Crowns50%
Crown inlay, onlay and veneer repairs50%
Crown recements50%
Post and Core50%
Implants50%
Inlays50%
Inlays/Onlays50%
Bridgework (abutment crowns and pontics)50%
Recements50%
Repairs50%
Dentures (complete and partials)50%
Adjustments50%
Repairs, relines and rebases50%
  
Dollar Maximum(per enrollee)PPO - $1,500 Premier & Out-of-Network $1,000
Deductible(per person/per family - excluding Preventive and Diagnostic)PPO - $50 Premier & Out-of-Network $150
OrthodonticsNot Covered
  
Plan BenefitPPO 3
Preventative & Diagnostic 
Exams100%
Cleanings100%
Bitewing X-rays100%
Full Mouth X-rays100%
Topical Floride100%
Sealants100%
Space maintainers100%
Basic Services 
Fillings80%
Composite/resin restorations80%
Simple Extractions80%
Root Canal Therapy (Endodontics)80%
Periodontal Maintenance80%
Scaling and Root Planning80%
Periodontal surgeries80%
Oral Surgery80%
General Anesthesia or IV sedation80%
Major Services 
Single Crowns50%
Stainless Steel Crowns50%
Crown inlay, onlay and veneer repairs50%
Crown recements50%
Post and Core50%
Implants50%
Inlays50%
Inlays/Onlays50%
Bridgework (abutment crowns and pontics)50%
Recements50%
Repairs50%
Dentures (complete and partials)50%
Adjustments50%
Repairs, relines and rebases50%
  
Dollar Maximum(per enrollee)$1,500
Deductible(per person/per family - excluding Preventive and Diagnostic)PPO - $50 Premier & Out-of-Network $150
OrthodonticsNot Covered
  
Plan BenefitPPO 2
Preventative & Diagnostic 
Exams100%
Cleanings100%
Bitewing X-rays100%
Full Mouth X-rays100%
Topical Floride100%
Sealants100%
Space maintainers100%
Basic Services 
Fillings100%
Composite/resin restorations100%
Simple Extractions100%
Root Canal Therapy (Endodontics)100%
Periodontal Maintenance100%
Scaling and Root Planning100%
Periodontal surgeries100%
Oral Surgery100%
General Anesthesia or IV sedation100%
Major Services 
Single Crowns60%
Stainless Steel Crowns60%
Crown inlay, onlay and veneer repairs60%
Crown recements60%
Post and Core60%
Implants60%
Inlays60%
Inlays/Onlays60%
Bridgework (abutment crowns and pontics)60%
Recements60%
Repairs60%
Dentures (complete and partials)60%
Adjustments60%
Repairs, relines and rebases60%
  
Dollar Maximum(per enrollee)PPO - $1,500 Premier & Out-of-Network $1,000
Deductible(per person/per family - excluding Preventive and Diagnostic)PPO - $50 Premier & Out-of-Network $150
OrthodonticsNot Covered