Essential Traditional

Blue Dental Essential Traditional offers comprehensive benefits at a lower premium cost with slightly higher out-of-pocket cost for covered services.

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Essential Traditional

PLAN

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Advantage Plus

NETWORK

Two out of three dollar signs for cost and three umbrellas out of three for coverage
Here are some plan features and benefits:
  • Coverage for major services such as dental surgery, root canals and crowns
  • Annual benefit maximum of $1,000
  • $75 annual deductible per member
  • No out-of-pocket costs and no deductible for preventive dental care – exams and cleanings
  • Coverage for simple extractions and fillings
  • Same level of coverage for adults and children

Essential Traditional
Benefits
Deductible per member1 $75
Benefit Maximum per member (in and out of network) $1,000
Diagnostic and Preventive Services Coinsurance (Contract Pays) Waiting Period
Routine Oral Exams, Cleanings and Consultations 100% None
All Oral X-Rays 50% None
Fluoride Treatments, Sealants 100% None
Palliative Treatment (Emergency) 80% None
Basic Services Coinsurance (Contract Pays) Waiting Period
Space Maintainers 50% None
Fillings, Endodontic Therapy, Root Canal 50% 6 months
Periodontics, General Anesthesia/Sedation, Prosthetic Repairs 50% 12 months
Simple Extractions 50% None
Surgical Extractions, Oral Surgery 50% 12 months
Crown Repair 50% 12 months
Major Services Coinsurance (Contract Pays) Waiting Period
Bridges, Dentures, Inlays, Onlays, Crowns 50% 12 months
Orthodontics Not Covered N/A
1Does not apply to diagnostic and preventive services
See contract and schedule of benefits for coverage exclusions and limitations
To take full advantage of your Blue Dental coverage, choose a dentist who participates in the Advantage Plus network.* Dentists in the Advantage Plus network provide covered services at a significant savings.
 
*Advantage Plus Network is administered by United Concordia Companies, Inc. United Concordia is an independent company that administers dental benefits on behalf of Blue Cross and Blue Shield of Louisiana.

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