Dental plan comparison

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After meeting the deductible, the member pays the following amounts for covered services. The deductible does not apply to some covered services. They are marked with †.

  Providence
Preventive
Providence
Essential
Providence
Essential Access
Providence
Advantage Access
Coverage Type In-network Out-of-network In-network Out-of-network In-network Out-of-network In-network Out-of-network
Network Providence  All other providers Providence  All other providers Providence All other providers Providence All other providers
Deductible None $50 $50 $25
Annual maximum None $1,000 $1,000 $1,500
Waiting period None None None None
Diagnostic and preventive services1 Covered in full†  Covered in full†  Covered in full† 10%† Covered in full† 10%† Covered in full† Covered in full†
Basic services2 N/A 20% 30% 20% 30% 20% 20%
Major services3 N/A 50% 60% 50% 50% 50% 50%
Out-of-network** MAC*  MAC  UCR 90th percentile  UCR 90th percentile
2019 Rates
Subscriber only $10.20 $29 $34.70 $38.60
Subscriber and spouse $20.15 $57.95 $69.40 $77.20
Subscriber and child(ren) $20.65 $52 $62.25 $69.25
Subscriber, spouse and child(ren) $30.55  $82.60 $98.90 $110.05

Orthodontics/orthodontia are not available.
*Maximum allowable charge by the provider
**Balance billing may apply for out-of-network services
1Includes routine exams, cleanings, bitewing X-rays, topical fluoride (age 16 and younger), space maintainers
2Includes restorative fillings, oral surgery, endodontics, periodontics
3Includes crowns, dentures, bridge work