BEST Life PPO Dental Plans

Benefits

High

Mid

Basic

In Network

Out-of-Network¹

In Network

Out-of-Network¹

In Network

Out-of-Network¹

Calendar Year Maximum

Choose your level of benefits

$2,500

$2,000

$2,000

$1,500

$1,500

$1,000

$2,000

$1,500

$1,500

$1,000

$1,000

$750

$1,500

$1,000

$1,000

$1,000

$1,000

$1,000

Class I Preventive Services

Routine oral exam, cleanings, fluoride treatment for children, x-rays, sealants

100% coverage of
eligible expenses

100% coverage of
eligible expenses

100% coverage of
eligible expenses

80% coverage of
eligible expenses

80% coverage of
eligible expenses

80% coverage of
eligible expenses

Deductible

$0

$0

$0

$0

$0

$0

Waiting Period

No

No

No

No

No

No

Class II Basic Services

Fillings (amalgam, porcelain & plastic), general anesthesia, emergency palliative treatment, space maintainers for children, pathology

90% coverage of
eligible expenses

80% coverage of
eligible expenses

80% coverage of
eligible expenses

80% coverage of
eligible expenses

80% coverage of
eligible expenses

50% coverage of
eligible expenses

Deductible

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Waiting Period

No

No

No

No

No

No

Class III Major Services

Crowns & gold fillings, inlays, onlays and pontics, fixed bridges, complete & partial dentures

60% coverage of
eligible expenses

50% coverage of
eligible expenses

50% coverage of
eligible expenses

50% coverage of
eligible expenses

50% coverage of
eligible expenses

50% coverage of
eligible expenses

Deductible

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Choose $0, $25, $50, $75 or $100

Waiting Period

12 months, unless waived

12 months, unless waived

12 months, unless waived

12 months, unless waived

12 months, unless waived

12 months, unless waived

Oral Surgery

Class II

Class II

Class II

Class II

Simple & surgical extractions under Class II, other oral surgery under Class III

Simple & surgical extractions under Class II, other oral surgery under Class III

Periodontics/Endodontics

Class II or Class III

Class II or III

Class II or III

Class II or III

Class II or Class III

Class II or Class III

Class IV Orthodontics (optional)

50% coverage for eligible expenses

50% coverage for eligible expenses

50% coverage for eligible expenses

50% coverage for eligible expenses

50% coverage for eligible expenses

50% coverage for eligible expenses

Waiting Period

12 months, unless waived

12 months, unless waived

12 months, unless waived

Child/Adult Lifetime Maxumum Benefit Availability

Child & adult ($1,000) or Child only ($1,500 or $1,000)

Child & adult ($1,000) or Child only ($1,500 or $1,000)

Child only ($1,500 or $1,000)

In-Network Providers

PPO Network

PPO Network

PPO Network

Supplemental Dental
Accident Benefit covers injury to sound, natural teeth

Up to $1,000 per accident

Up to $1,000 per accident

Up to $500 per accident

Children's Good Vision Benefit²

Yes

Yes

Yes

Reimbirsement Level

80th or 90th percentile

80th or 90th percentile

80th or 90th percentile