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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.

Essential 1000SR
Deductible Amount
IndividualNA
FamilyNA
Annual Maximum*
In Network$1,000
Out of Network$1,000
Employee pays after deductible
Preventive**
PPO100%
PPP100%
Out of Network80%
Minor/Basic services**
PPONA
PPPNA
Out of NetworkNA
Major Services**
PPONA
PPPNA
Out of NetworkNA
Endodontic/Periodontal***NA
Orthodontic Services****
PPONA
PPPNA
Out of NetworkNA
Orthodontic lifetime maximumNA
Maximum rolloverNA
Value 10000SR
Deductible Amount
Individual$50
Family$150
Annual Maximum*
In Network$1,000
Out of Network$1,000
Employee pays after deductible
Preventive**
PPO100%
PPP100%
Out of Network90%
Minor/Basic services**
PPO80%
PPP80%
Out of Network70%
Major Services**
PPO50%
PPP50%
Out of Network40%
Endodontic/Periodontal***Major
Orthodontic Services****
PPO50%
PPP50%
Out of Network40%
Orthodontic lifetime maximum$1,000
Maximum rolloverIncluded
Elite1000SR
Deductible Amount
Individual$50
Family$150
Annual Maximum*
In Network$1,000
Out of Network$1,000
Employee pays after deductible
Preventive**
PPO100%
PPP100%
Out of Network90%
Minor/Basic services**
PPO80%
PPP80%
Out of Network70%
Major Services**
PPO50%
PPP50%
Out of Network40%
Endodontic/Peridontal***Basic
Orthodontic Services****
PPO50%
PPP50%
Out of Network40%
Orthodontic lifetime maximum$1,000
Maximum rolloverIncluded
Elite 1500SR
Deductible Amount
Individual$50
Family$150
Annual Maximum*
In Network$1,500
Out of Network$1,000
Employee pays after deductible
Preventive**
PPO100%
PPP100%
Out of Network90%
Minor/Basic services**
PPO80%
PPP80%
Out of Network70%
Major Services**
PPO50%
PPP50%
Out of Network40%
Endodontic/Periodontal***Basic
Orthodontic Services****
PPO50%
PPP50%
Out of Network40%
Orthodontic lifetime maximum$1,500
Maximum rolloverIncluded
Elite 2000SR
Deductible Amount
Individual$50
Family$150
Annual Maximum*
In Network$2,000
Out of Network$1,500
Employee pays after deductible
Preventive**
PPO100%
PPP100%
Out of Network90%
Minor/Basic services**
PPO80%
PPP80%
Out of Network70%
Major Services**
PPO50%
PPP50%
Out of Network40%
Endodontic/Periodontal***Basic
Orthodontic Services****
PPO50%
PPP50%
Out of Network40%
Orthodontic lifetime maximum$2,000
Maximum rolloverIncluded

*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