Namara Marketplace
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2016 QHP Landscape NV Individual Market Dental
|
State Code
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County Name
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Metal Level
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Issuer Name
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Plan Id (Standard Component)
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Plan Marketing Name
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Plan Type
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Rating Area
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Child Only Offering
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Source
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Customer Service Phone Number Local
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Customer Service Phone Number Toll Free
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Customer Service Phone Number Tty
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Network Url
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Plan Brochure Url
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Summary Of Benefits Url
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Drug Formulary Url
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Routine Dental Services Adult 1
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Basic Dental Care Adult 1
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Major Dental Care Adult 1
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Orthodontia Adult 1
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Dental Check-Up For Children
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Basic Dental Care Child 1
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Major Dental Care Child 1
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Orthodontia Child 1
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Premium Rates
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Premium Child
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Premium Adult Individual Age 21
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Premium Adult Individual Age 27
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Premium Adult Individual Age 30
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Premium Adult Individual Age 40
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Premium Adult Individual Age 50
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Premium Adult Individual Age 60
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Premium Couple 21
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Premium Couple 30
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Premium Couple 40
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Premium Couple 50
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Premium Couple 60
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Couple+1 Child, Age 21
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Couple+1 Child, Age 30
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Couple+1 Child, Age 40
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Couple+1 Child, Age 50
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Couple+2 Children, Age 21
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Couple+2 Children, Age 30
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Couple+2 Children, Age 40
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Couple+2 Children, Age 50
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Couple+3 Or More Children, Age 21
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Couple+3 Or More Children, Age 30
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Couple+3 Or More Children, Age 40
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Couple+3 Or More Children, Age 50
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Individual+1 Child, Age 21
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Individual+1 Child, Age 30
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Individual+1 Child, Age 40
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Individual+1 Child, Age 50
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Individual+2 Children, Age 21
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Individual+2 Children, Age 30
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Individual+2 Children, Age 40
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Individual+2 Children, Age 50
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Individual+3 Or More Children, Age 21
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Individual+3 Or More Children, Age 30
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Individual+3 Or More Children, Age 40
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Individual+3 Or More Children, Age 50
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Standard On Exchange
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Dental Deductible - Individual - Standard
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Dental Deductible - Family - Standard
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Dental Deductible - Family (Per Person) - Standard
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Dental Maximum Out Of Pocket - Individual - Standard
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Dental Maximum Out Of Pocket - Family - Standard
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Dental Maximum Out Of Pocket - Family (Per Person) - Standard
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Routine Dental Services Adult
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Basic Dental Care Adult
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Major Dental Care Adult
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Orthodontia Adult
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Dental Checkup For Children
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Basic Dental Care Child
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Major Dental Care Child
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Orthodontia Child
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
NV
|
Carson City
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
30.6
|
32.7
|
32.7
|
32.7
|
32.7
|
32.7
|
61.2
|
65.4
|
65.4
|
65.4
|
65.4
|
92.97
|
97.17
|
97.17
|
97.17
|
124.74
|
128.94
|
128.94
|
128.94
|
156.51
|
160.71
|
160.71
|
160.71
|
62.37
|
64.47
|
64.47
|
64.47
|
94.14
|
96.24
|
96.24
|
96.24
|
125.91
|
128.01
|
128.01
|
128.01
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Carson City
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
22
|
23.5
|
23.5
|
23.5
|
23.5
|
23.5
|
44
|
47
|
47
|
47
|
47
|
75.77
|
78.77
|
78.77
|
78.77
|
107.54
|
110.54
|
110.54
|
110.54
|
139.31
|
142.31
|
142.31
|
142.31
|
53.77
|
55.27
|
55.27
|
55.27
|
85.54
|
87.04
|
87.04
|
87.04
|
117.31
|
118.81
|
118.81
|
118.81
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Carson City
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Churchill
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Churchill
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Churchill
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Clark
|
High
|
Nevada Dental Benefits, Ltd.
|
43126NV0110001
|
NDB Nevada Kids Gold
|
HMO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
http://nevadadentalbenefits.com/find_dentist.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
X
|
X
|
X
|
X
|
20.13
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
$35
|
$53
|
$350
|
|||||||||||||||||||||||||||||||||||||||||||||
|
NV
|
Clark
|
Low
|
Alpha Dental of Nevada, Inc.
|
34962NV0010006
|
DeltaCare USA Basic Plan for Families
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
https://www.deltadentalins.com/find-a-dentist
|
https://deltadentalins.com/hcx/nv/34962nv0010006-16
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
17.84
|
22.53
|
22.53
|
22.53
|
22.53
|
22.53
|
22.53
|
45.06
|
45.06
|
45.06
|
45.06
|
45.06
|
62.9
|
62.9
|
62.9
|
62.9
|
80.74
|
80.74
|
80.74
|
80.74
|
98.58
|
98.58
|
98.58
|
98.58
|
40.37
|
40.37
|
40.37
|
40.37
|
58.21
|
58.21
|
58.21
|
58.21
|
76.05
|
76.05
|
76.05
|
76.05
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
$5
|
$45
|
$350
|
$3,250
|
$5
|
$45
|
$350
|
$350
|
|||||||
|
NV
|
Clark
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
27.44
|
26.43
|
28.24
|
28.24
|
28.24
|
28.24
|
28.24
|
52.86
|
56.48
|
56.48
|
56.48
|
56.48
|
80.3
|
83.92
|
83.92
|
83.92
|
107.74
|
111.36
|
111.36
|
111.36
|
135.18
|
138.8
|
138.8
|
138.8
|
53.87
|
55.68
|
55.68
|
55.68
|
81.31
|
83.12
|
83.12
|
83.12
|
108.75
|
110.56
|
110.56
|
110.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Clark
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
27.44
|
19
|
20.3
|
20.3
|
20.3
|
20.3
|
20.3
|
38
|
40.6
|
40.6
|
40.6
|
40.6
|
65.44
|
68.04
|
68.04
|
68.04
|
92.88
|
95.48
|
95.48
|
95.48
|
120.32
|
122.92
|
122.92
|
122.92
|
46.44
|
47.74
|
47.74
|
47.74
|
73.88
|
75.18
|
75.18
|
75.18
|
101.32
|
102.62
|
102.62
|
102.62
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Clark
|
Low
|
Nevada Dental Benefits, Ltd.
|
43126NV0150001
|
NDB Nevada Kids + Adult
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
http://nevadadentalbenefits.com/find_dentist.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
16.9
|
16.9
|
16.9
|
16.9
|
16.9
|
16.9
|
16.9
|
33.8
|
33.8
|
33.8
|
33.8
|
33.8
|
50.7
|
50.7
|
50.7
|
50.7
|
67.6
|
67.6
|
67.6
|
67.6
|
84.5
|
84.5
|
84.5
|
84.5
|
33.8
|
33.8
|
33.8
|
33.8
|
50.7
|
50.7
|
50.7
|
50.7
|
67.6
|
67.6
|
67.6
|
67.6
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
No Charge
|
$50
|
$400
|
Not Covered
|
No Charge
|
$50
|
$75
|
$350
|
|||||||
|
NV
|
Clark
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
25.73
|
28.42
|
28.42
|
28.42
|
28.42
|
28.42
|
28.42
|
56.84
|
56.84
|
56.84
|
56.84
|
56.84
|
82.57
|
82.57
|
82.57
|
82.57
|
108.3
|
108.3
|
108.3
|
108.3
|
134.03
|
134.03
|
134.03
|
134.03
|
54.15
|
54.15
|
54.15
|
54.15
|
79.88
|
79.88
|
79.88
|
79.88
|
105.61
|
105.61
|
105.61
|
105.61
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Douglas
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
30.6
|
32.7
|
32.7
|
32.7
|
32.7
|
32.7
|
61.2
|
65.4
|
65.4
|
65.4
|
65.4
|
92.97
|
97.17
|
97.17
|
97.17
|
124.74
|
128.94
|
128.94
|
128.94
|
156.51
|
160.71
|
160.71
|
160.71
|
62.37
|
64.47
|
64.47
|
64.47
|
94.14
|
96.24
|
96.24
|
96.24
|
125.91
|
128.01
|
128.01
|
128.01
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Douglas
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
22
|
23.5
|
23.5
|
23.5
|
23.5
|
23.5
|
44
|
47
|
47
|
47
|
47
|
75.77
|
78.77
|
78.77
|
78.77
|
107.54
|
110.54
|
110.54
|
110.54
|
139.31
|
142.31
|
142.31
|
142.31
|
53.77
|
55.27
|
55.27
|
55.27
|
85.54
|
87.04
|
87.04
|
87.04
|
117.31
|
118.81
|
118.81
|
118.81
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Douglas
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Elko
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Elko
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Elko
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Esmeralda
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Esmeralda
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Esmeralda
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Eureka
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Eureka
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Eureka
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Humboldt
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Humboldt
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Humboldt
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Lander
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Lander
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Lander
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Lincoln
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Lincoln
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Lincoln
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Lyon
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
30.6
|
32.7
|
32.7
|
32.7
|
32.7
|
32.7
|
61.2
|
65.4
|
65.4
|
65.4
|
65.4
|
92.97
|
97.17
|
97.17
|
97.17
|
124.74
|
128.94
|
128.94
|
128.94
|
156.51
|
160.71
|
160.71
|
160.71
|
62.37
|
64.47
|
64.47
|
64.47
|
94.14
|
96.24
|
96.24
|
96.24
|
125.91
|
128.01
|
128.01
|
128.01
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Lyon
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
22
|
23.5
|
23.5
|
23.5
|
23.5
|
23.5
|
44
|
47
|
47
|
47
|
47
|
75.77
|
78.77
|
78.77
|
78.77
|
107.54
|
110.54
|
110.54
|
110.54
|
139.31
|
142.31
|
142.31
|
142.31
|
53.77
|
55.27
|
55.27
|
55.27
|
85.54
|
87.04
|
87.04
|
87.04
|
117.31
|
118.81
|
118.81
|
118.81
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Lyon
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Mineral
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Mineral
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Mineral
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Nye
|
High
|
Nevada Dental Benefits, Ltd.
|
43126NV0110001
|
NDB Nevada Kids Gold
|
HMO
|
Rating Area 1
|
Allows Child-Only
|
SERFF
|
http://nevadadentalbenefits.com/find_dentist.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
X
|
X
|
X
|
X
|
20.13
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
Not Covered
|
Not Covered
|
Not Covered
|
Not Covered
|
No Charge
|
$35
|
$53
|
$350
|
|||||||||||||||||||||||||||||||||||||||||||||
|
NV
|
Nye
|
Low
|
Alpha Dental of Nevada, Inc.
|
34962NV0010006
|
DeltaCare USA Basic Plan for Families
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
https://www.deltadentalins.com/find-a-dentist
|
https://deltadentalins.com/hcx/nv/34962nv0010006-16
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
17.84
|
22.53
|
22.53
|
22.53
|
22.53
|
22.53
|
22.53
|
45.06
|
45.06
|
45.06
|
45.06
|
45.06
|
62.9
|
62.9
|
62.9
|
62.9
|
80.74
|
80.74
|
80.74
|
80.74
|
98.58
|
98.58
|
98.58
|
98.58
|
40.37
|
40.37
|
40.37
|
40.37
|
58.21
|
58.21
|
58.21
|
58.21
|
76.05
|
76.05
|
76.05
|
76.05
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
$5
|
$45
|
$350
|
$3,250
|
$5
|
$45
|
$350
|
$350
|
|||||||
|
NV
|
Nye
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
27.44
|
26.43
|
28.24
|
28.24
|
28.24
|
28.24
|
28.24
|
52.86
|
56.48
|
56.48
|
56.48
|
56.48
|
80.3
|
83.92
|
83.92
|
83.92
|
107.74
|
111.36
|
111.36
|
111.36
|
135.18
|
138.8
|
138.8
|
138.8
|
53.87
|
55.68
|
55.68
|
55.68
|
81.31
|
83.12
|
83.12
|
83.12
|
108.75
|
110.56
|
110.56
|
110.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Nye
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
27.44
|
19
|
20.3
|
20.3
|
20.3
|
20.3
|
20.3
|
38
|
40.6
|
40.6
|
40.6
|
40.6
|
65.44
|
68.04
|
68.04
|
68.04
|
92.88
|
95.48
|
95.48
|
95.48
|
120.32
|
122.92
|
122.92
|
122.92
|
46.44
|
47.74
|
47.74
|
47.74
|
73.88
|
75.18
|
75.18
|
75.18
|
101.32
|
102.62
|
102.62
|
102.62
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Nye
|
Low
|
Nevada Dental Benefits, Ltd.
|
43126NV0150001
|
NDB Nevada Kids + Adult
|
HMO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
http://nevadadentalbenefits.com/find_dentist.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
http://www.nevadadentalbenefits.com/nevada_health_link.php
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
16.9
|
16.9
|
16.9
|
16.9
|
16.9
|
16.9
|
16.9
|
33.8
|
33.8
|
33.8
|
33.8
|
33.8
|
50.7
|
50.7
|
50.7
|
50.7
|
67.6
|
67.6
|
67.6
|
67.6
|
84.5
|
84.5
|
84.5
|
84.5
|
33.8
|
33.8
|
33.8
|
33.8
|
50.7
|
50.7
|
50.7
|
50.7
|
67.6
|
67.6
|
67.6
|
67.6
|
Not Applicable
|
Not Applicable
|
Not Applicable
|
350
|
700
|
350
|
No Charge
|
$50
|
$400
|
Not Covered
|
No Charge
|
$50
|
$75
|
$350
|
|||||||
|
NV
|
Nye
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 1
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
25.73
|
28.42
|
28.42
|
28.42
|
28.42
|
28.42
|
28.42
|
56.84
|
56.84
|
56.84
|
56.84
|
56.84
|
82.57
|
82.57
|
82.57
|
82.57
|
108.3
|
108.3
|
108.3
|
108.3
|
134.03
|
134.03
|
134.03
|
134.03
|
54.15
|
54.15
|
54.15
|
54.15
|
79.88
|
79.88
|
79.88
|
79.88
|
105.61
|
105.61
|
105.61
|
105.61
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Pershing
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
29.77
|
31.81
|
31.81
|
31.81
|
31.81
|
31.81
|
59.54
|
63.62
|
63.62
|
63.62
|
63.62
|
90.44
|
94.52
|
94.52
|
94.52
|
121.34
|
125.42
|
125.42
|
125.42
|
152.24
|
156.32
|
156.32
|
156.32
|
60.67
|
62.71
|
62.71
|
62.71
|
91.57
|
93.61
|
93.61
|
93.61
|
122.47
|
124.51
|
124.51
|
124.51
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Pershing
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
30.9
|
21.4
|
22.86
|
22.86
|
22.86
|
22.86
|
22.86
|
42.8
|
45.72
|
45.72
|
45.72
|
45.72
|
73.7
|
76.62
|
76.62
|
76.62
|
104.6
|
107.52
|
107.52
|
107.52
|
135.5
|
138.42
|
138.42
|
138.42
|
52.3
|
53.76
|
53.76
|
53.76
|
83.2
|
84.66
|
84.66
|
84.66
|
114.1
|
115.56
|
115.56
|
115.56
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Pershing
|
Low
|
Rocky Mountain Hospital and Medical Service, Inc., dba Anthem Blue Cross and Blue Shield
|
33670NV0980003
|
Anthem Dental Family
|
PPO
|
Rating Area 4
|
Allows Adult and Child-Only
|
SERFF
|
1-855-711-8949
|
1-855-711-8949
|
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=Anthem-BCBS&netcode=DVP
|
http://www.anthem.com/agent/nv/f0/s0/t0/pw_e214670.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
34.44
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
39.7
|
79.4
|
79.4
|
79.4
|
79.4
|
79.4
|
113.84
|
113.84
|
113.84
|
113.84
|
148.28
|
148.28
|
148.28
|
148.28
|
182.72
|
182.72
|
182.72
|
182.72
|
74.14
|
74.14
|
74.14
|
74.14
|
108.58
|
108.58
|
108.58
|
108.58
|
143.02
|
143.02
|
143.02
|
143.02
|
$100
|
See Plan Brochure
|
$100
|
350
|
700
|
350
|
No Charge after Deductible
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
10%
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50% Coinsurance after deductible
|
||||||
|
NV
|
Storey
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020005
|
BESTOne Plus Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Plus-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
30.6
|
32.7
|
32.7
|
32.7
|
32.7
|
32.7
|
61.2
|
65.4
|
65.4
|
65.4
|
65.4
|
92.97
|
97.17
|
97.17
|
97.17
|
124.74
|
128.94
|
128.94
|
128.94
|
156.51
|
160.71
|
160.71
|
160.71
|
62.37
|
64.47
|
64.47
|
64.47
|
94.14
|
96.24
|
96.24
|
96.24
|
125.91
|
128.01
|
128.01
|
128.01
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
30% Coinsurance after deductible
|
60% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
||||
|
NV
|
Storey
|
Low
|
BEST Life and Health Insurance Company
|
75719NV0020006
|
BESTOne Basic Silver
|
PPO
|
Rating Area 3
|
Allows Adult and Child-Only
|
SERFF
|
1-949-253-4080
|
1-800-433-0088
|
1-949-222-2134
|
http://www.bestlife.com/exchange/dentemax.html
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
https://www.bestlife.com/nv/2015/NV_BESTOne_Dental_Basic-Silver_Plan.pdf
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
31.77
|
22
|
23.5
|
23.5
|
23.5
|
23.5
|
23.5
|
44
|
47
|
47
|
47
|
47
|
75.77
|
78.77
|
78.77
|
78.77
|
107.54
|
110.54
|
110.54
|
110.54
|
139.31
|
142.31
|
142.31
|
142.31
|
53.77
|
55.27
|
55.27
|
55.27
|
85.54
|
87.04
|
87.04
|
87.04
|
117.31
|
118.81
|
118.81
|
118.81
|
$75
|
See Plan Brochure
|
$75
|
350
|
700
|
350
|
No Charge
|
50% Coinsurance after deductible
|
70% Coinsurance after deductible
|
Not Covered
|
No Charge
|
40% Coinsurance after deductible
|
50% Coinsurance after deductible
|
50%
|
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