Essential Certified

Blue Dental Essential Certified offers comprehensive benefits at a lower premium cost with slightly higher out-of-pocket cost for covered services.

Essential Certified

PLAN

=

Advantage Plus

NETWORK

Two out of three dollar signs for cost and three umbrellas out of three for coverage
Here are some plan features and benefits:
  • Coverage for major services such as dental surgery, root canals and crowns
  • Annual benefit maximum of $1,000
  • $75 annual deductible per adult; $50 annual deductible per child
  • No out-of-pocket costs and no deductible for preventive dental care – exams and cleanings
  • Coverage for simple extractions and fillings
  • Pediatric dental coverage and coverage for medically necessary orthodontia for children up to age 21
  • Coverage for adults age 21 and over
  • Coverage for in- and out-of-network services

Essential Certified

Benefits
Deductible (per adult member each year)1 $75
Deductible (per member under 21 per calendar year)1 $50
Adult benefit maximum per year - members age 21 and older $1,000
Child benefit maximum per year - members under age 21 Unlimited
Child out-of-pocket yearly maximum - members under age 21 $350 for 1 Child
$700 for 2 or more children
Child2 No Waiting Period Adult Contract Pays Adult Waiting Period
Routine Oral Exams and Cleanings1 100% 100% None
Oral X-Rays1 100% 50% None
Fluoride Treatments1, Sealants1 80% Not Covered Not Covered
Palliative Treatment (Emergency)1 100% 80% None
Basic Restorative (Amalgam, Resin Fillings), Endodontics 80% 50% 6 months
Oral Surgery, Surgical Extractions 80% 50% 12 months
Simple Extractions 80% 50% None
Periodontics - Surgical and Non-Surgical 80% 50% 12 months
Crowns, Crown Repairs, Prosthetics (Bridges, Dentures) 50% 50% 12 months
Implants - Must meet Dental Necessity Requirements 50% Not Covered Not Covered
Orthodontics (Members Under Age 21 Only)
Medically Necessary 50% Not Covered Not Covered
1Does not apply to diagnostic and preventive services
2Members under age 21. Certain benefits are limited to children younger than 18.
See contract and schedule of benefits for coverage exclusions and limitations