| 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 |