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Choose your plan and network
Our dental coverage offers you three different levels of coverage and two different networks.
Personal Dental Summary of Benefits
1. Choose one of three plans Maintenance, Major or Comprehensive.
COVERAGE |
Maintenance Plan
|
Major Plan
|
Comprehensive Plan |
In-
Network |
Out-of-
Network |
In-
Network |
Out-of-
Network |
In-
Network |
Out-of-
Network |
Diagnostic/preventive
(Routine check-up) |
100% |
80% |
0% |
0% |
100% |
80% |
Sealants |
100% |
80% |
100% |
80% |
100% |
80% |
Fillings |
50% - 80% |
50% |
50% - 80% |
50% |
50% - 80% |
50% |
Basic services |
0% |
0% |
50% - 80% |
50% |
50% - 80% |
50% |
Surgical services |
0% |
0% |
After six months |
50% |
50% |
50% |
50% |
Major restorative
(Crowns, bridges, etc.) |
0% |
0% |
After twelve months |
50% |
25% |
50% |
25% |
Annual deductible
(Per person) |
$50 |
$75 |
$50 |
$75 |
$50 |
$75 |
Annual plan maximum
(Per person) |
$1,250 |
$750 |
$1,250 |
$750 |
$1,250 |
$750 |
2. Choose a network within your plan. HealthPartners Dental Group has 15 clinics; Open Access has 1,750 providers.
Maintenance Plan
|
HealthPartners Dental Group
|
Under 50 |
$22.79 |
| 50 and Over |
$27.32 |
Dependent Rates |
| 1 Child |
$21.65 |
| 2 Children |
$43.30 |
3 or More Children |
$64.95 |
|
Under 50 |
$27.88 |
| 50 and Over |
$32.35 |
Dependent Rates |
| 1 Child |
$26.49 |
| 2 Children |
$52.97 |
3 or More Children |
$79.46 |
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Major Plan
|
HealthPartners Dental Group
|
Under 50 |
$16.82 |
| 50 and Over |
$20.20 |
Dependent Rates |
| 1 Child |
$15.98 |
| 2 Children |
$31.96 |
3 or More Children |
$47.94 |
|
Under 50 |
$21.87 |
| 50 and Over |
$26.26 |
Dependent Rates |
| 1 Child |
$20.77 |
| 2 Children |
$41.54 |
3 or More Children |
$62.32 |
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Comprehensive Plan |
HealthPartners Dental Group
|
Under 50 |
$32.31 |
| 50 and Over |
$38.78 |
Dependent Rates |
| 1 Child |
$30.70 |
| 2 Children |
$61.40 |
3 or More Children |
$92.09 |
|
Under 50 |
$39.98 |
| 50 and Over |
$47.98 |
Dependent Rates |
| 1 Child |
$37.98 |
| 2 Children |
$75.97 |
3 or More Children |
$113.95 |
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Rates effective July 1, 2008 - March 31, 2009.
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