The Dental Select Copay Plan makes dental insurance easy and affordable. There are no annual maximums to track and all copayments are fixed. Plus, routine exams, cleanings, and fluoride treatments are 100% covered after a low deductible is met on all services.
No Annual Maximum
Your smile is priceless. Learn about the CareCredit credit card and our special financing options for dental. Our healthcare credit card can be used for a variety of dental care and orthodontia procedures including dental implants, tooth repair, crowns or caps, root canals, dental implants, braces, retainers, bite plates, and headgears. Make Mom smile with a healthy affordable dental plan at $5 Dollar Copay this Mother's Day. With, $5 Extractions Office Visit and Second Opinion. $245 Crowns + Veneers for the look of perfect teeth and $125 Bleaching (per arch) it's sure to make and keep her smile healthy and happy.
There’s no annual maximum on your coverage, so you can utilize whatever benefits you need, as often as you need.
Network Options
Texas and Utah residents can choose between our regional Gold and Platinum networks at enrollment.
Short Waiting Periods
Take advantage of your full benefits within one year of your coverage start date.
Fixed Copay
Dental on a budget? Copays are fixed so you’ll always know what you’re going to pay prior to your appointment
Discounts
Where available, discounts may be available on child and adult orthodontics, veneers, and teeth bleaching. Discount amounts may vary.
In-Network
Dental Select Fee Schedule 2020
Dental Copays
Dental Copay Calculator
FAQ
Available on our Gold or Platinum networks (Utah and Texas only).
Currently, Dental Select offers plan effective dates are on the first day of each calendar month. You may choose your effective date during the plan selection process, where you also enter your zip code and number of dependents.
Dental Copay Assistance Programs
Dependents can include a spouse or domestic partner and each unmarried child, from birth to age 26, who is living with you in a regular parent-child relationship and for whom you can claim an exception on your federal taxes.
Yes. EyeMed Discount Vision is included with every dental plan. This is based on applicable laws, and reduced costs may vary by doctor location.
Discount Vision and Connection Hearing are also included. This is based on applicable laws, and reduced costs may vary by doctor location.
The Copay plan is only available in Texas and Utah. Click here to download a brochure.
Your deductible applies to all services and must be fully satisfied before plan benefits take effect.
Plan Highlights
- In-network preventive care is covered at 100%
- Fixed copays for procedures make budgeting easy
- No annual maximums
- No waiting periods
- Gold and Platinum network options
Legal
EXPENSES NOT COVERED: No benefits will be paid for expenses incurred:
In all states
- for services related to, performed in conjunction with, or resulting from a non-covered procedure.
- for charges in excess of the Contracted Fee Schedule or the Usual, Customary and Reasonable rate, whichever applies.
- for any treatment program which begins prior to the date the Insured is covered under the Policy.
- for crowns, inlays and onlays on teeth that can be restored by direct placement materials.
- for the replacement of crowns, bridges, inlays, onlays or prosthetic appliances within 5 years from the date of last placement.
- for any condition covered under any Workers’ Compensation Act or similar law.
- for services applied without cost by any municipality, county or other political subdivision or for which there would be no charge in the absence of insurance.
- for services that are applied toward the satisfaction of a Deductible, if any.
- for services subject to a Benefit Waiting Period.
- for charges resulting from changing from one provider to another while receiving treatment, or from receiving treatment from more than one provider for one dental procedure to the extent that the total charges billed exceed the amount incurred if one provider had performed all services.
- for Hospital facility charges for any dental procedure, including but not limited to: emergency room charges, surgical facility charges, Hospital confinement.
- for drugs or the dispensing of drugs.
- for oral hygiene instruction; plaque control; acid etch; prescription or take-home fluoride; broken appointments; completion of a claim form; OSHA/sterilization fees (Occupational Safety & Health Agency); or diagnostic photographs (except for orthodontic purposes).
- for implants (unless included in covered services); myofunctional therapy; athletic mouthguards; precision or semi-precision attachments; treatment of fractures, cysts, tumors, or lesions; maxillofacial prosthesis; orthognathic surgery; TMJ dysfunction; cleft palate; or anodontia.
- for orthodontia, unless included within the Benefit Schedule.
- for services to replace teeth that are missing (extracted or congenitally) prior to the Effective Date of the Policy. This limitation ends after 36 months of continuous coverage on the Policy. Abutment teeth will be reviewed for eligibility of prosthetic benefits.
- for composite, resin, or white fillings on posterior primary teeth. Benefits will be reduced to that of an amalgam or silver filling.
- for the replacement of a filling within 24 months of placement, unless for specific health reasons.
- for the replacement of retainers.
- for lab fees for higher metals or porcelain crowns, bridges, inlays, or onlays.
- during travel or activity outside the United States.
In Texas and Utah only
- for services and supplies not listed in the Benefit Schedule, not recognized as essential for the treatment of the condition according to accepted standards of practice or considered experimental, subject to the Right To Appeal provision contained in your Policy.
- for cosmetic procedures, including but not limited to veneers and bleaching of teeth and procedures performed primarily for cosmetic reasons, subject to the Right To Appeal provision contained in your Policy.
- for sealants not applied to permanent bicuspids or molars, applied at age 18 or older, applied 3 years from a previous sealant application, applied to a decayed tooth.
In all states, except Texas and Utah
- for services and supplies not listed in the Benefit Schedule, not recognized as essential for the treatment of the condition according to accepted standards of practice or considered experimental.
- for cosmetic procedures, including but not limited to veneers and bleaching of teeth and procedures performed primarily for cosmetic reasons.
- for sealants not applied to permanent bicuspids or molars, applied later than the end of the month in which a child reaches age 19, applied 3 years from a previous sealant application, applied to a decayed tooth.
This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit Us from providing insurance, including, but not limited to, the payment of claims.
This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit Us from providing insurance, including, but not limited to, the payment of claims.
| Basic Option | |
|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services |
| Physician Care | $30 for primary care1 |
| Virtual doctor visits by Teladoc® | $0 for first 2 visits |
| Urgent Care Center | $35 copay |
| Prescription Drugs | Preferred Retail Pharmacy: Tier 1 (Generics): $10 copay Tier 2 (Preferred brand): $55 copay2 Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)2 Tier 4 (Preferred specialty): $65 copay2 Tier 5 (Non-preferred specialty): $90 copay2 Mail Service Pharmacy: Available to members with Medicare Part B primary only. Visit the Medicare page for more information. Tier 1 (Generics): $20 Tier 2 (Preferred brand): $100 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy: Tier 4 (Preferred specialty): $85 copay2 Tier 5 (Non-preferred specialty): $110 copay2 |
| Maternity Care | $175 inpatient $0 outpatient |
| Hospital Care | Inpatient (Precertification is required): $175 per day; up to $875 per admission Outpatient: $100 per day per facility1 |
| Surgery | $150 in an office setting1 $200 in a non-office setting1 |
| ER (accidental injury) | $175 per day per facility |
| ER (medical emergency) | $175 per day per facility |
| Lab work (such as blood tests) | $0 copay1 |
| Diagnostic services (such as sleep studies, CT scans) | Up to $100 in an office1 Up to $150 in a hospital1 |
| Chiropractic Care | $30 per treatment; up to 20 visits per year |
| Dental Care | $30 copay per evaluation; up to 2 per year |
| Rewards Program | Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Online Health Coach goals3 |