Description | row |
---|---|
Description and Summary of Benefits | No charge or low copay for most procedures. |
Plan Features |
|
Exclusions |
|
County Information | The strongest networks are in the following counties:
|
Description | In Network Preventive | Out Network Preventive |
---|---|---|
Preventive Services | Copayment based on schedule of benefits | No benefit available |
Description | In Network Basic | Out Network Basic |
---|---|---|
Basic: (complete mouth X-rays, denture/partial repair, extractions, fillings, sealants for children) | Copayment based on schedule of benefits | No benefit available |
Description | In Network Major | Out Network Major |
---|---|---|
Major: (crowns, bridges, partials, dentures, root canals, periodontal treatment) | Copayment based on schedule of benefits | No benefit available |