Basic Blue
Option 1 Available to groups with 3 or more enrolled employees:
- Exam, X-rays, and cleaning at 100%
Option 2 Available to groups with 3 or more enrolled employees:
- Exam, X-rays, cleanings, and fluoride treatment
Advantage Blue
100/80/50
Option 1 No Deductible
Option 1 With Deductible
Available to groups with 3 or more enrolled employees:
- Basic covered at 100%
- Minor restorative and non-surgical periodontics covered at 80%
Option 2 No Deductible
Option 2 With Deductible
Available to groups with 3 or more enrolled employees:
- Basic covered at 100%
- Minor restorative and non-surgical periodontics covered at 80%
- Major restorative covered at 50%
Option 3 No Deductible
Option 3 With Deductible
Available to groups with 10 or more enrolled employees:
- Basic covered at 100%
- Minor restorative and non-surgical periodontics covered at 80%
- Major restorative covered at 50%
- Periodontics covered at 50%
Option 4 No Deductible
Option 4 With Deductible
Available to groups with 26 or more enrolled employees:
- Basic covered at 100%
- Minor restorative and non-surgical periodontics covered at 80%
- Orthodontics covered at 50%
Option 5 No Deductible
Option 5 With Deductible
Available to groups with 26 or more enrolled employees:
- Basic covered at 100%
- Minor restorative and non-surgical periodontics covered at 80%
- Major restorative covered at 50%
- Orthodontics covered at 50%
Option 6 No Deductible
Option 6 With Deductible
Available to groups with 26
or more enrolled employees:
- Basic covered at 100%
- Minor restorative and non-surgical periodontics covered at 80%
- Major restorative covered at 50%
- Prosthodontics, Periodontics and Orthodontics covered at 50%
Premier Blue
100/100/50
Option 1 Available to groups with 3 or more enrolled employees:
- Basic covered at 100%
- Minor restorative covered at 100%
Option 2* Available to groups with 3-25 enrolled employees:
- Basic covered at 100%
- Minor restorative covered at 100%
- Major restorative covered at 100%
- Periodontics covered at 50%
Option 2* Available to groups with 26 or more enrolled employees
- Basic covered at 100%
- Minor restorative covered at 100%
- Major restorative covered at 100%
- Periodontics covered at 50%
Option 3* Available to groups with 10-25 enrolled employees:
- Basic covered at 100%
- Minor restorative covered at 100%
- Major restorative covered at 50%
- Periodontics covered at 50%
- Prosthodontics covered at 50%
Option 3* Available to groups with 26 or more enrolled employees:
- Basic covered at 100%
- Minor restorative covered at 100%
- Major restorative covered at 100%
- Periodontics covered at 50%
- Prosthodontics covered at 50%
Option 4* Available to groups with 26 or
more enrolled employees:
- Basic covered at 100%
- Minor restorative covered at 100%
- Major restorative covered at 100%
- Periodontics covered at 50%
- Orthodontics covered at 50%
Option 5* Available to groups with 26
or more enrolled employees:
- Basic covered at 100%
- Minor restorative covered at 100%
- Major restorative covered at 100%
- Periodontics covered at 50%
- Prosthodontics covered at 50%
- Orthodontics covered at 50%
* A $50 per member deductible and 50% coinsurance applies to major restorative, periodontics, and prosthodontics for groups with less than 26 enrolled employees.
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