BEST Life PPO Dental Plans for Arizona, California and Nevada

Benefits

High Plan

Mid Plan

Basic Plan

Value Plan

In-Network

Out-of-Network¹

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

$1,500

$1,500

$1,500

$2,000

$1,500

$1,500

$1,000

$1,000

$1,000

$1,000

$1,000

$1,500

$1,000

$1,000

$1,000

$500

$500

$500

$500

$1,000

$1,000

Individual Deductible (3 per family max)

Applies to Basic and Major Services

$0, $25, $50, $75 or $100 per Calendar Year

$0, $25, $50, $75 or $100 per Calendar Year

$0, $25, $50, $75 or $100 per Calendar Year

$0, $25, $50, $75 or $100 per Calendar Year

Class I: Preventive Services

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

100%

100%

100%

80%

100%

80%

100%

80%

Class II: Basic Services

Fillings (amalgam, porcelain & plastic), anterior & posterior composites, anesthesia (general or intravenous sedation), emergency palliative treatment, space maintainers for children, pathology

90%

80%

80%

80%

80%

50%

50%

20%

Class III: Major Services

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

60%

50%

50%

50%

0%

0%

0%

0%

Waiting Period

12 months, unless waived

12 months, unless waived

None

None

Periodontics/Endodontics

Class II or Class III

Class II or III

Class II or Class III

Class II or Class III

Class IV: Orthodontics (optional)

50%

50%

Not offered

Not offered

Child Only Benefit Availability

(Children through age 18)

$1,000 Lifetime Maximum with a $500 Calendar Year Maximum or $1,500 Lifetime with a $750 Calendar Year Maximum

$1,000 Lifetime Maximum with a $500 Calendar Year Maximum or $1,500 Lifetime with a $750 Calendar Year Maximum

Child and Adult Benefit Availability

$1,000 Lifetime Maximum with a $500 Calendar Year Maximum

$1,000 Lifetime Maximum with a $500 Calendar Year Maximum

Waiting Period

12 months, unless waived

12 months, unless waived

Special Dental Accident Benefit

Covers injury to sound, natural teeth

Up to $1,000 per accident

Up to $1,000 per accident

Up to $1,000 per Accident

Up to $1,000 per Accident

Children's Good Vision Benefit²

Included with purchase of Orthodontia

Included with purchase of Orthodontia

Not offered

Not offered

Reimbursement Level

80th or 90th Percentile or Maximum Allowable Charge

80th or 90th Percentile or Maximum Allowable Charge

80th or 90th Percentile or Maximum Allowable Charge

80th or 90th Percentile or Maximum Allowable Charge