Employers
Dental Select PPO Plus traditional plans
Here is a selection of the most popular traditional group dental plans for employers with 2-50 employees. With these plans, employers pay a portion of the member’s premium. We have many other plans to consider also.
You’ll notice three different coinsurance numbers. The first coinsurance amount is when members visit providers exclusively in the PPO network. The second coinsurance is the broad DentalBlue PPP network. The third coinsurance number is for services received from out-of-network providers.
| Value 10000SR | |
|---|---|
| Deductible Amount | |
| Individual | $50 |
| Family | $150 |
| Annual Maximum* | |
| In Network | $1,000 |
| Out of Network | $1,000 |
| Employee pays after deductible | |
| Preventive** | |
| PPO | 100% |
| PPP | 100% |
| Out of Network | 90% |
| Minor/Basic services** | |
| PPO | 80% |
| PPP | 80% |
| Out of Network | 70% |
| Major Services** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Endodontic/Periodontal*** | Major |
| Orthodontic Services**** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Orthodontic lifetime maximum | $1,000 |
| Maximum rollover | Included |
| Elite1000SR | |
|---|---|
| Deductible Amount | |
| Individual | $50 |
| Family | $150 |
| Annual Maximum* | |
| In Network | $1,000 |
| Out of Network | $1,000 |
| Employee pays after deductible | |
| Preventive** | |
| PPO | 100% |
| PPP | 100% |
| Out of Network | 90% |
| Minor/Basic services** | |
| PPO | 80% |
| PPP | 80% |
| Out of Network | 70% |
| Major Services** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Endodontic/Periodontal*** | Basic |
| Orthodontic Services**** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Orthodontic lifetime maximum | $1,000 |
| Maximum rollover | Included |
| Elite 1500SR | |
|---|---|
| Deductible Amount | |
| Individual | $50 |
| Family | $150 |
| Annual Maximum* | |
| In Network | $1,500 |
| Out of Network | $1,000 |
| Employee pays after deductible | |
| Preventive** | |
| PPO | 100% |
| PPP | 100% |
| Out of Network | 90% |
| Minor/Basic services** | |
| PPO | 80% |
| PPP | 80% |
| Out of Network | 70% |
| Major Services** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Endodontic/Periodontal*** | Basic |
| Orthodontic Services**** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Orthodontic lifetime maximum | $1,500 |
| Maximum rollover | Included |
| Elite 2000SR | |
|---|---|
| Deductible Amount | |
| Individual | $50 |
| Family | $150 |
| Annual Maximum* | |
| In Network | $2,000 |
| Out of Network | $1,500 |
| Employee pays after deductible | |
| Preventive** | |
| PPO | 100% |
| PPP | 100% |
| Out of Network | 90% |
| Minor/Basic services** | |
| PPO | 80% |
| PPP | 80% |
| Out of Network | 70% |
| Major Services** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Endodontic/Periodontal*** | Basic |
| Orthodontic Services**** | |
| PPO | 50% |
| PPP | 50% |
| Out of Network | 40% |
| Orthodontic lifetime maximum | $2,000 |
| Maximum rollover | Included |
*Annual max for Par/Non-Par is cumulative not separate for all plans
**Periodontal maintenance is not covered in P5000 and PV5000 (D4910). Periodontal maintenance is covered as a basic service in plans P5001, P5002, P5003, P5004, PV5001, PV5002, PV5003, PV5004
***Refers to endodontic (root canals, etc.), Periodontic (treatment of gum disease, etc.) and certain oral surgery procedures
****Orthodontic services are limited to covered persons through age 18