To qualify for coverage on an Individual dental plan, you must also be enrolled on a SelectHealth Individual medical plan. For information about applying for a medical plan, click here.
Benefits and rates shown below are effective January 1, 2012 through December 31, 2012. Our three dental plan options are as follows:
Option 1
- $750 Annual Maximum per Person
- Deductible – $50/$150 (individual/family)
- Preventive – Plan pays 100%
- Basic – You pay 20% after deductible
- Major – You pay 50% after deductible
| Subscriber's Age |
Single |
Two Party |
Family |
| 18 and younger |
$20 |
$38 |
$58 |
| 19 to 39 |
$35 |
$69 |
$104 |
| 40 to 64 |
$49 |
$95 |
$143 |
| 65 and older |
$56 |
$107 |
$162 |
Option 2
- $1,000 Annual Maximum per Person
- Deductible – $50/$150 (individual/family)
- Preventive – Plan pays 100%
- Basic – You pay 20% after deductible
- Major – You pay 50% after deductible
| Subscriber's Age |
Single |
Two Party |
Family |
| 18 and younger |
$22 |
$42 |
$64 |
| 19 to 39 |
$39 |
$76 |
$115 |
| 40 to 64 |
$54 |
$105 |
$158 |
| 65 and older |
$61 |
$119 |
$179 |
Option 3
- $1,500 Annual Maximum per Person
- Deductible – $50/$150 (individual/family)
- Preventive – You pay 10%
- Basic – You pay 30% after deductible
- Major – You pay 50% after deductible
| Subscriber's Age |
Single |
Two Party |
Family |
| 18 and younger |
$21 |
$41 |
$62 |
| 19 to 39 |
$38 |
$74 |
$111 |
| 40 to 64 |
$52 |
$101 |
$153 |
| 65 and older |
$59 |
$115 |
$173 |