Smile Brighter. See Clearly. Live Better

Key Details
Routine checkups and cleanings help reduce inflammation that can affect your overall health.
Early treatment prevents costly procedures and future health complications.

What to Know About Dental & Vision
Benefits, waiting periods, and annual maximums vary by plan and state.
Out-of-network costs and discounts may differ from in-network providers.
Dental and vision coverage are designed to complement—not replace—your main health insurance.

Fast Next Steps
Have your preferred dentist or optometrist information and any prescriptions ready.
We’ll compare plan options and bundling choices to find the best value for you.

Key Details
Annual eye exams can reveal systemic health conditions through retinal changes.
Corrective lenses improve safety, focus, and productivity—whether at work, school, or on the road.

What to Know About STM
Benefits, waiting periods, and annual maximums vary by plan and state.
Out-of-network costs and discounts may differ from in-network providers.
Dental and vision coverage are designed to complement—not replace—your primary health insurance.

Fast Next Steps
Have your preferred dentist or optometrist information and any prescriptions ready.
We’ll compare plan options and bundling opportunities to help you find the best value.

Key Details
Regular cleanings, X-rays, and exams help prevent costly dental procedures.
Many plans include discounts on frames, lenses, and contact lenses.

What to Know About Dental & Vision
Benefits, waiting periods, and annual maximums vary by plan and state.
Out-of-network costs and discounts may differ from in-network providers.
Dental and vision coverage are designed to complement—not replace—your primary health insurance.

Fast Next Steps
Have your preferred dentist or optometrist information and any prescriptions ready.
We’ll review plan options and bundling opportunities to find the best value for you.

Key Details
Regular cleanings, X-rays, and exams help prevent costly dental procedures.
Many plans include discounts on frames, lenses, and contact lenses.

What to Know About Dental & Vision
Benefits, waiting periods, and annual maximums vary by plan and state.
Out-of-network costs and discounts may differ from in-network providers.
Dental and vision coverage are designed to complement—not replace—your primary health insurance.

Fast Next Steps
Have your preferred dentist or optometrist information and any prescriptions ready.
We’ll review plan options and bundling opportunities to find the best value for you.

Routine checkups: Every 6 months for exams and cleanings to remove plaque and catch early decay.

X-rays: Bitewing or panoramic images as needed to detect hidden problems before they become costly.

Coverage level: Most plans cover preventive care at or near 100% with no waiting period (details vary).

Why it matters: Regular visits are the simplest, most affordable way to avoid fillings, crowns, and root canals later.

Fluoride varnish: Strengthens enamel to prevent decay; often covered for children and teens.

Sealants: Thin coatings applied to molars to block bacteria in hard-to-brush areas.

Frequency: Fluoride may be reapplied every 3–12 months; sealants can last several years with touch-ups.

Cost benefit: Prevents cavities early—saving money on fillings and repairs later.

Fillings: Resin (white) or amalgam materials restore teeth after decay removal.

Extractions: Simple or surgical removal for unsalvageable or impacted teeth.

Coverage tiers: Typically listed as basic services with coinsurance after deductible; waiting periods may apply.

Pain management: Local anesthesia included; sedation coverage varies by plan.

Root canal therapy: Removes infected pulp to stop pain and save the natural tooth.

Crowns: Custom porcelain, zirconia, or metal caps restore strength and function.

When needed: For deep decay, cracks, or after large fillings—often used together.

Coverage: Usually classified as major services with higher coinsurance and possible waiting periods.

Fixed bridges: Replace missing teeth by anchoring a bridge between crowned neighboring teeth.

Dentures: Partial or full removable options that restore chewing comfort and clear speech.

Implants: Titanium posts topped with crowns for the most natural look, feel, and stability.

Coverage notes: Typically considered major services with annual maximums and frequency limits; implant coverage varies by plan.

Appliances: Traditional braces or clear aligners to fix crowding, spacing, and bite issues.

Age & limits: Most plans cover dependents; adult coverage may require an upgrade or buy-up.

Waiting periods: Often apply, with lifetime orthodontic maximums common.

Value: Enhances bite function and oral hygiene—not just appearance.

Scaling & root planing: Removes tartar below the gumline and smooths roots to promote healing.

Maintenance visits: More frequent cleanings help control inflammation after therapy.

Advanced care: Some plans cover localized antibiotics or surgical treatment if needed.

Health connection: Treating gum disease supports heart health, diabetes control, and pregnancy wellness.

What’s included: Urgent exams, pain relief, temporary fillings, and infection control.

Common events: Severe toothaches, broken or knocked-out teeth, abscesses, or lost crowns.

How it bills: Usually covered as basic services; follow-up treatment may bill separately.

Tip: Seek care within hours after injury to improve the chance of saving the tooth.

Vision testing: Refraction determines your glasses or contact lens prescription.

Health screening: Detects glaucoma, cataracts, macular degeneration, and other eye conditions.

Frequency: Usually 1 exam every 12 months; copay amounts vary by plan.

Why yearly: Even small vision changes impact reading, driving, and screen comfort—especially for kids.

Frame benefit: Pick from covered styles or use your allowance toward premium brands.

Lenses: Single-vision, bifocal, or trifocal options; progressive upgrades often discounted.

Frequency: Typically every 12–24 months; separate from contact lens benefits.

Tip: Visit in-network optical shops for the best value on designer frames.

Fitting exam: Confirms lens type and fit for comfort, vision clarity, and healthy oxygen flow.

Supplies: Allowances apply to daily, bi-weekly, or monthly lenses—including toric and multifocal.

Either/or: Most plans let you choose glasses or contacts benefits per benefit period.

Care savings: Get discounts on lens solutions and cases at participating retailers.

Coatings: Anti-reflective and scratch-resistant options keep lenses clear and durable.

Materials: High-index, polycarbonate, or Trivex lenses offer thinner, lighter strength.

Upgrades: Blue-light filtering and photochromic (light-adaptive) lenses often discounted.

Progressives: Provide seamless near-to-far vision correction as a bifocal alternative.

What you get: Reduced pricing or allowances for laser vision correction at participating centers.

Eligibility: Requires doctor approval and stable prescriptions; not all qualify.

Budgeting: HSA/FSA funds may apply—ask about stacking discounts.

Note: Most vision plans offer LASIK/PRK as a discount program, not an insured benefit.

In-network value: Enjoy lower copays and higher allowances when you stay in network.

Choice: Access both private practices and major retail optical chains (varies by plan).

Out-of-network: Reimbursements may apply, but benefits are usually reduced.

Ease: Most providers can verify eligibility and file claims instantly.

What it is: The fixed monthly amount you pay for your dental or vision plan.

How it works: Paid directly to the insurer; ACA subsidies don’t apply. The premium keeps your policy active but doesn’t directly reduce dentist or eye doctor bills.

What affects it: Age, location, plan level (basic vs. premium), and number of covered members.

Pro tip: Compare monthly cost to expected use—if you get regular exams and cleanings, a higher-tier plan may save more overall.

Example: Around $28/month (vision) or $38/month (dental) to maintain coverage.

What it is: A yearly amount—typically $50–$100 per person—that you pay first for covered dental services.

How it works: Often waived for preventive care (cleanings, exams, X-rays) but applies to basic and major treatments like fillings, crowns, or root canals.

Watch for: Separate family deductibles or per-person limits may apply.

Example: With a $50 deductible, you pay the first $50 of covered basic or major services each plan year.

What it is: The yearly dollar limit—typically $1,000–$2,000—that your plan pays per member.

After you hit it: You’re responsible for 100% of additional dental costs until the next plan year.

Pro tip: Schedule major procedures (like multiple crowns) across plan years to maximize benefits.

What it includes

Exam copay: Flat fee (e.g., $10–$20) at your visit.

Frame allowance: Spending credit (e.g., $150) toward frames.

Lenses/contacts: Copays or an allowance (e.g., $130 for contacts).

Example
$10 exam copay + $150 frame allowance every 12–24 months (varies by plan).

Pro tip
Ask the optical shop to apply your allowance before add-ons (anti-glare, blue light) to see your true out-of-pocket cost.

What it is: Preventive care may start immediately, but basic or major services often have 3–12 month waits.

Why it exists: Designed to prevent short-term enrollment just to file large claims.

Watch for: Major treatments like crowns, bridges, or implants usually have the longest waits. Some higher-tier plans offer no waiting periods for a higher premium.

What it is

A network of approved dentists, optometrists, and vision retailers offering discounted rates.

Why it matters

Using in-network providers means lower costs and easier claims. Out-of-network visits may have reduced coverage or higher bills.

Example

An in-network cleaning might cost $95 instead of $150—saving you money right away.

What it is
Rules that limit or exclude certain dental and vision procedures from coverage.

Common Exclusions

Cosmetic: Whitening, veneers, or purely aesthetic work

Orthodontia: Often child-only with a lifetime max

Missing tooth clause: No coverage for teeth lost before enrollment

Vision: LASIK/PRK usually discount-only, not covered

Out-of-Network & UCR
Reimbursements may be capped at “usual, customary, reasonable” rates—meaning you could owe the balance.

Pro tip
Planning major treatment? Ask for a pre-treatment estimate to see costs before you commit.