If you choose a Traditional plan, you must see participating providers on your Select Health.
Participating
Non-Participating
Participating
DEDUCTIBLE
$50/$150
Non-Participating
DEDUCTIBLE
$50/$150
Participating
ANNUAL MAXIMUM PLAN PAYMENT
Individual
$750/$1,000/$1,500
Non-Participating
ANNUAL MAXIMUM PLAN PAYMENT
Individual
$750/$1,000/$1,500
Participating
PREVENTIVE AND DIAGNOSTIC
Oral exams, cleanings, fluoride, x-rays (No waiting period)
Plan pays 100%/90%
Non-Participating
PREVENTIVE AND DIAGNOSTIC
Oral exams, cleanings, fluoride, x-rays (No waiting period)
Plan pays 80%/70%
Participating
BASIC
Fillings, oral surgery, anesthesia for basic services (Six month waiting period without prior Select Health dental coverage)
Plan pays 80%/70% after deductible
Non-Participating
BASIC
Fillings, oral surgery, anesthesia for basic services (Six month waiting period without prior Select Health dental coverage)
Plan pays 60%/50% after deductible
Participating
MAJOR
Crowns, bridges, dentures, anesthesia for major services, endodontics and periodontics (12 month waiting period without prior Select Health dental coverage)
Plan pays 50% after deductible
Non-Participating
MAJOR
Crowns, bridges, dentures, anesthesia for major services, endodontics and periodontics (12 month waiting period without prior Select Health dental coverage)