Choose your plan and network
Our dental coverage offers you three different levels of coverage and two different networks.
Personal Dental Summary of Benefits
Please note that applicants under the age of 19 need to fill out a paper application: Personal Dental Coverage Application
1. Choose one of three plans Maintenance, Major or Comprehensive.
Coverage | Maintenance Plan | Major Plan | Comprehensive Plan | |||
|---|---|---|---|---|---|---|
In- | Out-of- | In- | Out-of- | In- | Out-of- | |
Diagnostic/preventive | 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 | 0% | 0% | After twelve months | |||
| 50% | 25% | 50% | 25% | |||
Annual deductible | $50 | $75 | $50 | $75 | $50 | $75 |
Annual plan maximum | $1,250 | $750 | $1,250 | $750 | $1,250 | $750 |
2. Choose a network - HealthPartners Dental Group or Open Access.
3. Choose the correct rate for your age and gender. Include spouse age and number of children if applicable.
Rates effective April 1, 2012 - December 31, 2012
The rates for this plan may change on January 1, 2013.