The Copay plan offers a special waiting period feature where a member’s waiting period if any will be reduced by the number of months the member was covered by the prior plan. Prior proof of coverage is required and effective dates must be within the previous 24 months.

Plan Summary

In-Network

Out-of-Network

Preventive
In-Network
100%
Out-of-Network
100% of Fee Schedule (General Dentist Only)
Basic
In-Network
Up to 70% (Copay applies)
Out-of-Network
Up to 705 of Fee Schedule (General Dentist Only)
Major
In-Network
Up to 50% covered (Copay applies)
Out-of-Network
Up to 50% of Fee Schedule (General Dentist Only)
Deductible
In-Network
$25/$75 per person / per family
Out-of-Network
Annual Maximum
In-Network
No Maximum
Out-of-Network
Waiting Period
Basic
In-Network
6 Months
Out-of-Network
Waiting Period
Major
In-Network
12 Months
Out-of-Network
Orthodontics
In-Network
20% Discount (Contracted Provider)
Out-of-Network
No Benefit
Orthodontic Maximum
In-Network
No Maximum
Out-of-Network
N/A
Waiting Period
Orthodontics
In-Network
None
Out-of-Network
N/A

FAQ

Which networks can I use?
When is my plan effective?
Who can I include on my plan?
Does my plan include Vision?
Additional inclusions for Seniors
What if I require specialist services?
Where can I find a copy of my plan brochure?
To which services does my deductible apply?
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