Dental & Vision Insurance Made Simple

Regular cleanings help prevent gum disease, which is linked to heart issues, diabetes, and pregnancy complications — supporting your overall long-term health.

Key Details
Routine exams and cleanings help reduce inflammation that can impact overall health.
Early care prevents expensive treatments and future health issues.

What to Know About Dental & Vision Plans
Benefits, waiting periods, and annual limits vary by plan and state.
In-network providers typically offer greater savings than out-of-network options.
Dental and vision coverage work alongside — not as a replacement for — your main health insurance.

Next Steps
Have your preferred dentist or eye doctor and any current prescriptions ready.
We’ll help you compare plans and bundle options to find the best coverage and value.

Regular eye exams can detect glaucoma, cataracts, diabetes, and high blood pressure early—often before you notice any symptoms.

Key Details
Annual eye exams can reveal broader health issues through retinal changes.
Corrective lenses improve safety, focus, and performance at work, school, and on the road.

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

Next Steps
Have your preferred dentist or eye doctor and any prescriptions ready.
We’ll help you compare plan options and bundles to find the best value.

Dental crowns and eyewear can be costly, but insurance helps make routine care affordable and protects you from unexpected expenses.

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

What to Know About Dental & Vision Plans
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 complement — not replace — your primary health insurance.

Next Steps
Keep your preferred dentist or eye doctor and any prescriptions handy.
We’ll help you compare plans and bundle options to maximize value.

Combine dental and vision coverage, from routine checkups to unexpected emergencies. One plan, one less worry, one smarter choice.

Key Details
Coordinated dental and vision benefits simplify care for the whole family.
Coverage for both routine visits and unexpected treatments helps keep life on track.

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

Next Steps
Have your preferred dentist or eye doctor and any prescriptions ready.
We’ll help you compare plans and bundle options to get the best value.

Routine Checkups: Usually every 6 months for an exam and cleaning to remove plaque and detect early decay.
X‑Rays: Bitewing or panoramic X‑rays as recommended to uncover hidden issues before they become expensive problems.

Coverage Level: Many plans cover preventive care at or near 100% with little to no waiting period (details vary by plan).

Why It Matters: Preventive visits are the most cost-effective way to avoid fillings, crowns, and root canals down the line.

Fluoride Varnish: Strengthens enamel to help prevent decay, often covered for children and teens.

Sealants: Thin protective coatings applied to molars to block bacteria in grooves that brushing can miss.

Frequency: Fluoride may be reapplied every 3–12 months depending on risk; sealants can last for years with occasional touch-ups.

Cost Benefit: Helps avoid costly fillings by preventing cavities before they develop.

Fillings: Resin (white) or amalgam materials used to restore a tooth after decay is removed.

Extractions: Simple or surgical removal of teeth that can’t be saved, including impacted wisdom teeth.

Coverage Tiers: Typically considered “basic services,” with coinsurance after a deductible; waiting periods may apply.

Pain Management: Local anesthesia is usually included; sedation coverage depends on the plan.

Root Canal Therapy: Removes infected pulp, preserves the tooth, and relieves nerve pain.

Crowns: Custom caps (porcelain, zirconia, or metal) placed over damaged teeth to restore strength and function.

When Needed: Used for deep decay, cracks, or after large fillings; often performed together.

Coverage: Usually classified as a “major service” with higher coinsurance and potential waiting periods.

Fixed Bridges: Replacement teeth anchored between crowns on adjacent teeth.

Dentures: Partial or full removable options to restore chewing and speech.

Implants: Titanium posts serve as artificial roots, topped with crowns for natural look and stability.

Coverage Notes: Usually classified as a “major service” with annual maximums and frequency limits; implant coverage varies by plan.

Appliances: Traditional braces or clear aligners to correct crowding, spacing, and bite alignment.

Age & Limits: Many plans cover children and teens; adult orthodontics may be limited or require an optional upgrade.

Waiting Periods: Often applies, with lifetime orthodontic maximums typical.

Value: Enhances dental function and hygiene, not just appearance.

Scaling & Root Planing: Removes tartar below the gumline and smooths tooth roots to help gums reattach.

Maintenance Visits: More frequent cleanings after treatment to control inflammation.

Advanced Care: Some plans may cover localized antibiotics or surgical referrals as needed.

Health Connection: Treating gum disease supports overall health, including heart, diabetes, and pregnancy outcomes.

What’s Included: Urgent exams, temporary treatments, pain relief, and infection control.

Common Situations: Severe toothaches, broken or knocked-out teeth, abscesses, or lost fillings/crowns.

How It’s Billed: Typically covered as basic services; follow-up definitive care may be billed separately.

Tip: Seek care quickly—ideally within hours—to maximize the chance of saving a damaged tooth.

Vision Testing: Refraction to determine your glasses or contact lens prescription.

Health Screening: Evaluates for glaucoma, cataracts, macular degeneration, and other eye conditions.

Frequency: Usually one exam every 12 months; copays vary by plan.

Why Yearly: Even minor changes can impact driving, reading, and screen use—especially for children.

Frame Benefit: Select from covered styles or use an allowance toward premium frames.

Lenses: Single-vision, bifocal, or trifocal lenses, with discounts often available for progressive upgrades.

Frequency: Typically every 12–24 months, separate from contact lens coverage.

Tip: Use in-network optical providers to maximize value, especially for designer frames.

Fitting Exam: Ensures lenses fit your eyes comfortably and provide proper oxygen flow.

Supplies: Includes allowances for daily, bi-weekly, or monthly contacts, including toric and multifocal options.

Choice Flexibility: Many plans let you select either glasses or contacts benefits during a benefit period.

Care Savings: Receive discounts on cleaning solutions and cases at participating retailers.

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

Materials: High-index, polycarbonate, or Trivex lenses offer thinner, lighter, and impact-resistant options.

Upgrades: Blue-light filtering and photochromic (light-adaptive) lenses are often available at a discount.

Progressives: Provide seamless near-to-far vision correction as an alternative to bifocals; upgrade fees may apply.

What You Get: Discounts or allowances toward LASIK or PRK at participating clinics.

Eligibility: Requires a doctor’s evaluation and a stable prescription; not all prescriptions qualify.

Budgeting: HSA or FSA funds may be applied—check if you can combine savings.

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

Pediatric Exams: Annual comprehensive eye exams to identify vision issues that can affect learning.

Glasses Benefits: Covered frames and lenses designed for active children, with impact-resistant materials recommended.

Fit & Comfort: Proper adjustments help prevent headaches and squinting; replacement frames may be discounted.

Tip: Schedule exams before school starts to ensure kids begin the year with clear vision.

In-Network Value: Enjoy lower copays and higher allowances when using in-network providers.

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

Out-of-Network: Reimbursement may be available, though benefits are usually lower.

Ease: Many providers can verify eligibility and process claims immediately.

What It Is
The fixed monthly amount you pay to maintain your dental or vision plan.

How It Works
Paid directly to your insurance provider; ACA subsidies do not apply.
Keeps your policy active but doesn’t reduce costs at the dentist or eye doctor by itself.

What Affects It
Age, location, plan level (basic vs. premium), and whether family members are included.

Pro Tip
Compare your monthly premium to anticipated usage—annual cleanings and an eye exam may justify a higher-tier plan.

Example
$28/month for vision or $38/month for dental coverage.

What It Is
The annual amount (typically $50–$100 per person) you pay first for covered dental services.

How It Works
Often waived for preventive care, such as cleanings, exams, and X-rays.
Applies to basic and major services, including fillings, crowns, and root canals.

Watch For
Family deductibles or per-person limits may apply.

Example
A $50 deductible means you pay the first $50 of covered basic or major services each plan year.

What It Is
The annual dollar limit (typically $1,000–$2,000) your insurer will pay per member.

After You Hit It
You are responsible for 100% of additional dental expenses until the next plan year.

Pro Tip
Consider spacing major procedures, such as multiple crowns, across different plan years to maximize benefits.

What It Is
Some plans cover preventive care right away but delay coverage for basic or major services, typically 3–12 months.

Why It Exists
To discourage enrolling solely to file a large claim and then canceling the plan.

Watch For
Major services like crowns, bridges, and implants often have the longest waiting periods.
Some plans offer “no waiting period” options, usually with higher premiums.

What It Includes
Exam Copay: Flat fee at the visit (e.g., $10–$20).
Frame Allowance: Spending credit toward frames (e.g., $150).
Lenses/Contacts: Copays or allowances (e.g., $130 for contacts).

Example
$10 exam copay + $150 frame allowance every 12–24 months, depending on the plan.

Pro Tip
Ask your optical provider to apply your allowance before add-ons (like anti-glare or blue-light coatings) to see the true out-of-pocket cost.

What It Is
A directory of in-network dentists, optometrists, and retail vision providers offering pre-negotiated rates.

Why It Matters
Using in-network providers usually means lower costs and easier claims. Out-of-network care may reimburse less or follow UCR (usual, customary, reasonable) limits.

Example
An in-network cleaning billed at $95 versus $150 out-of-network—the difference is your responsibility according to plan rules.

Dental
Cleanings: Typically 2 per year (every 6 months).
X-Rays: Bitewings every 12 months; full set every 3–5 years.

Vision
Exam: Usually every 12 months.
Frames: Every 12–24 months, depending on plan tier.
Contact Lens Allowance: Typically every 12 months in place of frames/lenses.

Pro Tip
Use your benefits before the year ends—unused coverage generally does not roll over.

Common Exclusions
Cosmetic: Procedures like tooth whitening, veneers, and other purely cosmetic treatments.
Orthodontia: Often excluded or limited to child dependents with a lifetime maximum.
Missing Tooth Clause: No coverage for teeth lost before your plan began.
Vision: LASIK is usually not covered, though some plans offer discounts.

Out-of-Network & UCR
Reimbursements may be capped at “usual, customary, reasonable” rates, which could leave you responsible for the remaining balance.

Pro Tip
Planning major dental work? Request a pre-treatment estimate to understand your out-of-pocket costs before the procedure.

What It Includes
Covers routine preventive care and helps with common basic dental procedures.
Preventive: Cleanings, exams, bitewing X-rays (frequency limits apply).
Basic: Fillings, simple extractions (subject to deductible and coinsurance).
Optional Networks: Access in-network providers for lower out-of-pocket costs.

Why Pair It with STM
STM doesn’t cover routine dental, so this plan keeps day-to-day care affordable.
Prevents minor issues from turning into costly problems.
Predictable costs for twice-yearly cleanings.
Network savings help stretch your budget further.

Gotchas / Fine Print
Waiting periods and annual maximums often apply.
Major services (crowns, root canals) may have longer waits or lower coverage.
Annual benefit caps apply; out-of-network care may result in balance billing.
Frequency limits exist for cleanings, exams, and X-rays.

What It Include
Covers a routine eye exam and provides a spending allowance for eyewear.
Exam: Comprehensive annual eye exam (copay or set benefit).
Eyewear Allowance: Credit toward frames, lenses, or contact lenses.
Discounts: In-network savings on lens options like anti-glare or progressive lenses.

Why Pair It with STM
STM doesn’t cover routine vision, so adding this plan gives benefits people actually use.
Keep prescriptions up to date for safer driving and reduced eye strain.
Manage eyewear costs with predictable allowances.
Access both major retail chains and local optical providers.

Gotchas / Fine Print
Vision coverage is typically allowance-based with frequency limits.
Frame, lens, and contact benefits usually follow 12–24 month rules.
Out-of-network reimbursements may be lower than retail prices.
Some lens upgrades may carry additional charges.

What It Includes
A combined dental and vision plan offering routine care in one budget-friendly package.
Dental: Cleanings, exams, and basic services according to plan schedule.
Vision: Annual eye exam plus eyewear allowance.
Convenience: Single enrollment with consolidated billing.

Why Pair It with STM
Most households benefit from both; bundling saves money and simplifies management.
Lower total monthly cost compared to buying separate plans.
One place to manage routine care for the entire family.
Encourages consistent coverage habits year-round.

Gotchas / Fine Print
Dental and vision maintain separate rules and limits within the bundle.
Waiting periods, annual maximums, and frequency limits may still apply.
In-network provider use significantly impacts out-of-pocket costs.
Availability and rules vary by state and insurance carrier.