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