Value Traditional

Blue Dental Value Traditional offers maximum savings for individuals and families.

Value Traditional

PLAN

=

Advantage Plus

NETWORK

One out of three dollar signs for cost and two 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 $500
  • $0 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

Value Traditional

Benefits
Deductible per member1 $0
Benefit Maximum per member (in and out of network) $500
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 Not Covered N/A
Palliative Treatment (Emergency) 100% None
Basic Services Coinsurance (Contract Pays) Waiting Period
Space Maintainers Not Covered N/A
Fillings, Endodontic Therapy, Root Canal 60% None
Periodontics, General Anesthesia/Sedation, Prosthetic Repairs Not Covered N/A
Simple Extractions 60% None
Surgical Extractions, Oral Surgery 60% None
Crown Repair Not Covered N/A
Major Services Coinsurance (Contract Pays) Waiting Period
Bridges, Dentures, Inlays, Onlays, Crowns Not Covered N/A
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.