Select Plan Basic The Select Plan Basic1 offers great value and extended coverage for your money. Dentists from our exclusive Select Plan network provide most services and charge according to the Description of Benefits and Member Copayments. Select Plan members have access to one of the largest Dental HMO-style networks in the Mid-Atlantic. In fact, 93% of members have access to 2 Select Plan dentists within 10 miles of their homes.2 PREVENTION REWARDS PROGRAM Get Cleanings. Get Rewarded! The primary subscriber will receive a $20 reward from Dominion for themselves and each enrolled family member who gets two cleanings in a calendar year from a participating dentist. no waiting periods, annual maximum limits, preauthorization requirements or deductibles. Copayments for the Select Plan Basic are paid directly to your dentist at the time of service. If specialty care is required, your dentist will refer you to a participating specialist who will provide care at a 25% discount. Select Plan Basic benefits include $13 CHARGE for routine semiannual cleanings ADDITIONAL CLEANINGS covered for diabetics and expecting mothers ORTHODONTICS (adults and children) FIXED FEES for dental procedures DISCOUNTS on all implant services "NO-CHARGE" PROCEDURES account for over 79% of dental services most frequently performed for adults, and 90% of the most frequently performed services for children.3 Savings on extensive care including fillings, crowns, dentures, root canals, periodontal care, oral surgery, implant services and more. SELECT PLAN BASIC: KIDS By enrolling in the Select Plan Basic, dependents under the age of 19 will automatically be enrolled in our pediatric dental plan. Review covered procedures. ANNUAL SAVINGS ON THE MOST COMMONLY PERFORMED DENTAL PROCEDURES.4 The example below outlines how much an individual subscriber (age 30) may pay for in-office visits, annual premiums and copayments. service avg cost4 you pay you save Comprehensive Oral Exam $73 $0 $73 Complete Series X-rays $190 $26 $164 Adult Cleaning (Includes 2 per year) $122×2=$244 $13×2=$26 $218 Filling (3 Surface/Silver) $345 $64 $281 Crown (Porcelain/Metal) $1,278 $523 $755 Total Spent in Annual Premiums – $176 – Total Spent in Office Visit Fees ($10/visit for 3 visits)5 – $30 – TOTALS $2,130 $845 $1,491 ADDITIONAL SAVINGS ON MAJOR PROCEDURES service avg cost4 you pay you save Root Canal (Anterior Tooth) $1,157 $341 $816 Extraction, Erupted Tooth $235 $69 $166 Complete Denture $2,218 $697 $1,521 Perio Scaling/Root Planing $346 $109 $237 1 Managed care plan with exclusive network, fixed member copayments, no annual maximum dollar limits, no waiting periods and no deductibles. 2 Dominion National Network Analysis Report, 2023. Mid-Atlantic includes D.C., Delaware, Maryland, New Jersey, Pennsylvania and Virginia. Participating dentists are subject to change. 3 Dominion National - based on annual review of PPO utilization data. 4 Based on the Context4Healthcare’s 80th percentile for zip 220. Coverage for orthodontia is based on Dominion National’s 80th percentile of in-network and out-of-network claims data for D8080 and D8090 from 2016-2019. Average costs vary based on region. 5 Assumes oral exam, X-rays, cleaning and filling occur in the same visit and crown requires two visits. Also assumes first crown treatment and cleaning occur in the same visit. < Back
