SMILE. WE'VE GOT YOU COVERED.

Dental Benefits For Everyone.

Select Plan PREMIUM

 

 

The Select Plan Premium (same as a DHMO)1 offers the best value and coverage for your money.
Dentists from our exclusive Select Plan network provide most services and charge according to the Description of Benefits and Member Copayments.
Over 250 procedures are covered! Upon sign up, the complete list of covered procedures will be mailed to you with your membership card.
 
no claim forms, waiting periods, maximum limits, preauthorization requirements or deductibles.
 
Copayments under the Select Plan Premium are paid directly to your dentist at the time of service.
If specialty care is required, your dentist will refer you to a participating specialist who will provide care at a 25% discount.

Select Plan premium benefits include

 
NO CHARGE for routine semiannual cleanings (additional cleaning is covered for expecting mothers and diabetics)
 
 
NO CHARGE for oral examinations
    NO CHARGE for bitewing x-rays
 
 
    NO CHARGE for topical fluoride for children
 
 
    DISCOUNT on all implant services

 

THESE "NO-CHARGE" PROCEDURES
account for over 65% of dental services most frequently performed for adults, and 90% of the most frequently performed services for children.2

 

EXTENSIVE CARE FEES ARE
70% LOWER
THAN USUAL & CUSTOMARY CHARGES. ORTHODONTIA IS ALSO COVERED FOR ADULTS AND CHILDREN!
(SUCH AS FILLINGS, CROWNS, DENTURES, ROOT CANALS, PERIODONTAL CARE, ORAL SURGERY, IMPLANT SERVICES, ETC.)
SELECT PLAN PREMIUM:
KIDS
By enrolling in the Select Plan Premium, dependents under the age of 19 will automatically be enrolled in our pediatric dental plan. Review covered procedures.
 
ANNUAL SAVINGS ON THE MOST COMMONLY PERFORMED DENTAL PROCEDURES.*
The example below is based on an individual subscriber (age 30) and includes how much you would pay in office visits, annual premiums and copayments.

service avg cost* you pay you save
Oral Exam $86 $0 $86
Full Mouth X-rays $130 $26 $104
Teeth Cleaning (Includes 2 per year) $90×2=$180 $0 $180
Silver Filling (Two Surfaces) $151 $46 $105
Composite Filling (Two Surfaces) $190 $76 $114
Crown (Porcelain Fused to Metal) $1,210 $495 $715
Total Spent in Annual Premiums $225
Total Spent in Office VisitCopays ($10/visit for 3 visits)** $30
TOTALS $1,947 $898 $1,032

 

ADDITIONAL SAVINGS ON MAJOR PROCEDURES
service avg cost* you pay you save
Root Canal (Molar) $897 $488 $409
Surgical Extraction - Erupted Tooth $260 $63 $197
Denture (Complete Upper/Lower) $1,493 $664 $829
Periodontal Scaling/Root Planing $247 $105 $142

 

1 There are fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no claim forms or proof of loss (except in the case of out-of-area emergencies).
2 Dominion National - based on annual review of utilization data.
*Average costs based on the Captiva Context Fee Schedule's 80th percentile for zip codes beginning with 235. Average costs vary based on region.
**Assumes oral exam, x-rays, cleaning and filling occur in the same visit and crown requires two visits (also assumes first crown treatment and cleaning occur in the same visit).