Plan Benefit

Enhanced Plan The   percent you pay after your deductible (where required)

Classic Plan The   percent you pay after your deductible (where required)

Clear Plan You pay the fixed dollar amount   shown below

Cleanings

0%

20%

$60

Exams

0%

20%

(included   in cleaning)

Bitewing X-rays

0%

20%

(included   in cleaning)

Topical Fluoride

0%

20%

(included   in cleaning)

Fillings

50%

50% (12-month waiting period may apply)

$90

Crowns

50% (12-month waiting period may apply)

50% (12-month waiting period may apply)

$700

Implants

50% (12-month waiting period may apply)

50% (12-month waiting period may apply)

$2,500

Root Canals

50% (12-month waiting period may apply)

50% (12-month waiting period may apply)

$500

Non-Surgical Extractions

50% (12-month waiting period may apply)

50% (12-month waiting period may apply)

$90

Dollar Maximum (per   person per policy year)

$1,000

$1,000

None

Deductible (per   policy year)

$50/person (does not apply to routine   procedures like cleanings, exams, X-rays and topical fluoride)

$50/person (does not apply to routine   procedures like cleanings, exams, X-rays and topical fluoride)

None

Annual Contract Required

Yes

No

Yes

 

 

 

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