The Standard High Dental Insurance Plan Specifics
View Plan Rates by State
Benefit Maximum:
Per Person, Per Calendar Year: $2000
Deductible:
(applies to Type 2 and 3 services only)
Per Person, Per Calendar Year: $50
Type 1 deductible waived
No family maximum
Insured Percent:
| Type 1 |
Type 2 |
Type 3 |
| 100% |
80% |
50% |
Type 1 Services - No Waiting Periods, 100% covered
- Routine Oral Exams - Once every 6 Months.
- Routine Dental Cleaning - Once every 6 Months.
- Bitewing X-Rays - once every 12 months.
- Full Mouth or Panoramic X-Rays - Once every 5 years.
- Periapical X-Rays
- Flouride treatments - For children 13 and under. One per benefit period.
- Sealants - Ages 13 and under.
- Space maintainers
Type 2 Services - No Waiting Periods, 80% covered
- Restorative Amalgams
- Restorative Composites
- Endodontics - nonsurgical
- Denture Repair
- Simple extractions
Type 3 Services - No Waiting Periods, 50% covered
- Onlays
- Crowns - 1 in 10 years per tooth.
- Crown Repair
- Endodontics - surgical
- Periodontics - nonsurgical
- Periodontics - surgical
- Prosthodontics - fixed bridge; removable complete/partial dentures covered once per 10 years.
- Complex Extractions
- Anesthesia
Please Select A State to view Standard Dental rates
Alaska, Colorado, Idaho, Montana, Oregon, Utah, Washington, or Wyoming
Standard High Dental Rates - Washington, Oregon, and Idaho
Bi-Weekly Deductions - based on 26 pay periods per year
| Employee Rate |
$ |
42.00 |
| Emp & Spouse Rate |
$ |
71.00 |
| Emp & Child(ren) Rate |
$ |
71.00 |
| Emp, Spouse & Child(ren) |
$ |
104.00 |
Monthly Deductions
| Employee Rate |
$ |
91.00 |
| Emp & Spouse Rate |
$ |
153.83 |
| Emp & Child(ren) Rate |
$ |
153.83 |
| Emp, Spouse & Child(ren) |
$ |
225.33 |
Standard High Dental Rates - Colorado, Montana, and Wyoming
Bi-Weekly Deductions - based on 26 pay periods per year
| Employee Rate |
$ |
25.00 |
| Emp & Spouse Rate |
$ |
39.00 |
| Emp & Child(ren) Rate |
$ |
44.00 |
| Emp, Spouse & Child(ren) |
$ |
58.00 |
Monthly Deductions
| Employee Rate |
$ |
54.17 |
| Emp & Spouse Rate |
$ |
84.50 |
| Emp & Child(ren) Rate |
$ |
95.33 |
| Emp, Spouse & Child(ren) |
$ |
125.67 |
Standard High Dental Rates - Utah
Bi-Weekly Deductions - based on 26 pay periods per year
| Employee Rate |
$ |
30.00 |
| Emp & Spouse Rate |
$ |
46.00 |
| Emp & Child(ren) Rate |
$ |
50.08 |
| Emp, Spouse & Child(ren) |
$ |
65.80 |
Monthly Deductions
| Employee Rate |
$ |
65.00 |
| Emp & Spouse Rate |
$ |
99.67 |
| Emp & Child(ren) Rate |
$ |
108.50 |
| Emp, Spouse & Child(ren) |
$ |
142.57 |
Standard High Dental Rates - Alaska
Bi-Weekly Deductions - based on 26 pay periods per year
| Employee Rate |
$ |
39.00 |
| Emp & Spouse Rate |
$ |
65.00 |
| Emp & Child(ren) Rate |
$ |
65.00 |
| Emp, Spouse & Child(ren) |
$ |
103.00 |
Monthly Deductions
| Employee Rate |
$ |
84.50 |
| Emp & Spouse Rate |
$ |
140.83 |
| Emp & Child(ren) Rate |
$ |
140.83 |
| Emp, Spouse & Child(ren) |
$ |
223.17 |