Smile: we've got your dental plan

Protect your smile with one of our PPO or HMO dental plans. You’ll enjoy a range of dental benefits including exams, cleanings, and x-rays for $0.

Not sure which plan to choose? We can help. HMO plans generally cost less per month and have lower out-of-pocket costs for services compared with PPO plans. PPO plans offer more flexibility in your choice of dentist. You can add a vision plan for as little as $6.50 per month to round out your coverage.

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Apply for dental coverage:

You can enroll in a dental plan by calling (855)-656-0460.

Apply online

Compare plan benefits

Bolded values = Benefit is subject to a deductible

	Dental Standard HMO	Dental HMO	Enhanced Dental PPO 25/500	Enhanced Dental PPO 50/1250	Dental PPO	Specialty Duo^SM dental + vision package*	Enhanced Dental PPO 50/2000	Enhanced Dental PPO 50/2000 Lifetime Ortho 1500
Monthly rates starting at:	$11.50	$22.30	$25.40	$31.50	$36.40	$41.10	$49.90	$54.30
Benefit	With participating providers, members pay:¹
Diagnostic and preventive services	$0	$0	0%	0%	$0²	$0²	0%	0%
Restorative services – fillings	$20	$18	20%³	20%³	$37⁴	$37⁴	20%³	20%³
Oral surgery	$75	$70	20%³	20%³	$40⁴	$40⁴	20%³	20%³
Removal of impacted tooth	$225	$125	50%⁵	50%⁵	$113⁴	$113⁴	50%⁵	50%⁵
Root canal (anterior root canal)	$175	$155	50%⁵	50%⁵	$156⁴	$156⁴	50%⁵	50%⁵
Root canal (molar)	$355	$290	50%⁵	50%⁵	$234⁴	$234⁴	50%⁵	50%⁵
Crowns	$350⁶	$300⁶	50%⁵	50%⁵	$320⁵	$320⁵	50%⁵	50%⁵
Orthodontics	$2,350 for under age 26, fully banded, two years $2,650 for age 26+, fully banded, two years	$2,350 for under age 26, fully banded, two years⁵ $2,650 for age 26+, fully banded, two years⁵	Not covered	Not covered	$2,350 for under age 26, fully banded, two years^5,7 $2,650 for age 26+, fully banded, two years^5,7	$2,350 for under age 26, fully banded, two years^5,7 $2,650 for age 26+, fully banded, two years^5,7	Not covered	50% ($1,500 lifetime maximum and subject to separate deductible)^5,7,8
Denture	$400	$400	50%⁵	50%⁵	$388⁵	$388⁵	50%⁵	50%⁵
Calendar-year deductible	$0	$0	$25 per individual/$75 per family	$50 per individual/$150 per family	$50 per individual	$50 per individual	$50 per individual/$150 per family	$50 per individual/$150 per family
Calendar-year benefit maximum	None	None	$500 per individual	$1,250 per individual	$1,000 per individual	$1,000 per individual	$2,000 per individual	$2,000 per individual

* Underwritten by Blue Shield of California Life & Health Insurance Company. This plan also includes vision coverage.

1. The amounts indicated are a percentage of the allowed charges. Network providers accept Blue Shield’s allowed charges as payment in full for covered services.

2. Diagnostic and preventive services do not apply to the calendar-year benefit maximum for this plan.

3. There is a six-month waiting period for these services unless you had prior coverage.

4. There is a three-month waiting period for these services unless you had prior coverage. Contact Member Services at (888) 271-4880 for more information about obtaining a waiver.

5. There is a 12-month waiting period for these services unless you had prior coverage. Contact Member Services at (888) 271-4880 for more information about obtaining a waiver.

6. If precious metals are used, the member will be charged at the dentist’s cost. For Dental HMO, porcelain on molar teeth is subject to an additional charge of $75.

7. Amounts do not accrue toward the calendar-year benefit maximum.

8. Lifetime maximum is per person. Deductible is $50 per person or $150 per family.

Page last updated: 10/01/2020