Preferred Traditional

Blue Dental Preferred Traditional offers the highest level of complete coverage.

Preferred Traditional

PLAN

=

Advantage Plus

NETWORK

Three 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
  • $50 annual deductible per member
  • No out-of-pocket costs and no deductible for preventive dental care -- exams and cleanings
  • Coverage for simple extractions and fillings
  • Same level of coverage for adults and children

Preferred Traditional

Benefits
Deductible per member1 $50
Benefit Maximum per member (in and out of network) $1,000
Diagnostic and Preventive Services Coinsurance (Contract Pays) Waiting Period
Routine Oral Exams, Cleanings and Consultations 100% None
All Oral X-Rays 100% None
Fluoride Treatments, Sealants 100% None
Palliative Treatment (Emergency) 80% None
Basic Services Coinsurance (Contract Pays) Waiting Period
Space Maintainers 80% None
Fillings, Endodontic Therapy, Root Canal 80% 6 month
Periodontics, General Anesthesia/Sedation, Prosthetic Repairs 80% 12 month
Simple Extractions 80% None
Surgical Extractions, Oral Surgery 80% 12 month
Crown Repair 50% 12 month
Major Services Coinsurance (Contract Pays) Waiting Period
Bridges, Dentures, Inlays, Onlays, Crowns 50% 12 month
Orthodontics Not Covered N/A
1Does not apply to diagnostic and preventive services
See contract and schedule of benefits for coverage exclusions and limitations
To take full advantage of your Blue Dental coverage, choose a dentist who participates in the Advantage Plus network* Dentists in the Advantage Plus network provide covered services at a significant saving.