BlueDental Plus and BlueDental Basic Benefit Summaries

Benefit summaries are now available for the health plans listed below. Please check the site frequently for summary updates.

Please note: Not all services and procedures are covered by your benefits contract. Benefit summaries are for comparison purposes only and does not create rights not given through the benefit plan.

NOTE: Employers can consult with a CareFirst account executive to explore other plan options that fit their organization's benefit needs.

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BlueDental Plus 1-50 (Employer-Sponsored or Voluntary)

Plan* Deductible Annual Max In-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Out-of-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Dental Summary
Ortho No Ortho
1 In: $25/$75
Out: $50/$150		 $1,500 100/80/80/50 100/80/80/50 SUM2592 SUM2580
2 In: $25/$75
Out: $50/$150		 $1,500 100/80/80/50 80/60/60/35 SUM2593 SUM2581
3 In: $25/$75
Out: $50/$150		 $1,500 100/80/50/50 100/80/50/50 SUM2594 SUM2582
4 In: $25/$75
Out: $50/$150		 $1,500 100/80/50/50 80/60/35/35 SUM2595 SUM2583
5 In: $25/$75
Out: $50/$150		 $2,000 100/80/80/50 100/80/80/50 SUM2596 SUM2584
6 In: $25/$75
Out: $50/$150		 $2,000 100/80/80/50 80/60/35/35 SUM2597 SUM2585
7 In: $25/$75
Out: $50/$150		 $2,000 100/80/50/50 100/80/50/50 SUM2598 SUM2586
8 In: $25/$75
Out: $50/$150		 $2,000 100/80/50/50 80/60/35/35 SUM2599 SUM2587

BlueDental Plus 51+ (Employer-Sponsored or Voluntary)

* Note: Plan options 1-8 are available as both Employer-Sponsored1 or Voluntary2. Plan options 9-20 are only available as Employer-Sponsored.

Plan* Deductible Annual Max In-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Out-of-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Orthodontic
Lifetime
Maximum		 Dental Summary
Plan 11,2 In: $25/$75
Out: $50/$150		 $1,500 100/80/80/50 100/80/80/50 N/A SUM2580
$1,000 SUM6046
$1,200 SUM6048
$1,500 SUM2592
$2,000 SUM6050
Plan 21,2 In: $25/$75
Out: $50/$150		 $1,500 100/80/80/50 80/60/60/35 N/A SUM2581
$1,000 SUM6054
$1,200 SUM6056
$1,500 SUM2593
$2,000 SUM6058
Plan 31,2 In: $25/$75
Out: $50/$150		 $1,500 100/80/50/50 100/80/50/50 N/A SUM2582
$1,000 SUM6078
$1,200 SUM6080
$1,500 SUM2594
$2,000 SUM6082
Plan 41,2 In: $25/$75
Out: $50/$150		 $1,500 100/80/50/50 80/60/35/35 N/A SUM2583
$1,000 SUM6086
$1,200 SUM6088
$1,500 SUM2595
$2,000 SUM6090
Plan 51,2 In: $25/$75
Out: $50/$150		 $1,500 100/80/80/50 100/80/80/50 N/A SUM2584
$1,000 SUM6062
$1,200 SUM6064
$1,500 SUM2596
$2,000 SUM6066
Plan 61,2 In: $25/$75
Out: $50/$150		 $2,000 100/80/80/50 80/60/35/35 N/A SUM2585
$1,000 SUM6070
$1,200 SUM6072
$1,500 SUM2597
$2,000 SUM6074
Plan 71,2 In: $25/$75
Out: $50/$150		 $2,000 100/80/50/50 100/80/50/50 N/A SUM2586
$1,000 SUM6094
$1,200 SUM6096
$1,500 SUM2598
$2,000 SUM6098
Plan 81,2 In: $25/$75
Out: $50/$150		 $2,000 100/80/50/50 80/60/35/35 N/A SUM2587
$1,000 SUM6102
$1,200 SUM6104
$1,500 SUM2599
$2,000 SUM6106
Plan 91 In: $50/$150
Out: $50/$150		 $1,000 100/80/50/50 100/80/50/50 N/A SUM5984
$1,000 SUM5988
$1,200 SUM5990
$1,500 SUM5992
$2,000 SUM5994
Plan 101 In: $50/$150
Out: $50/$150		 $1,000 100/80/80/50 100/80/80/50 N/A SUM5912
$1,000 SUM5916
$1,200 SUM5918
$1,500 SUM5920
$2,000 SUM5922
Plan 111 In: $50/$150
Out: $50/$150		 $1,500 100/80/50/50 100/80/50/50 N/A SUM5996
$1,000 SUM6000
$1,200 SUM6002
$1,500 SUM6004
$2,000 SUM6006
Plan 121 In: $50/$150
Out: $50/$150		 $1,500 100/80/80/50 100/80/80/50 N/A SUM5924
$1,000 SUM5928
$1,200 SUM5930
$1,500 SUM5932
$2,000 SUM5934
Plan 131 In: $25/$75
Out: $50/$150		 $1,500 100/90/60/60 100/90/60/60 N/A SUM6008
$1,000 SUM6012
$1,200 SUM6014
$1,500 SUM6016
$2,000 SUM6018
Plan 141 In: $50/$150
Out: $50/$150		 $1,500 100/90/60/60 100/90/60/60 N/A SUM6020
$1,000 SUM6024
$1,200 SUM6026
$1,500 SUM6028
$2,000 SUM6030
Plan 151 In: $25/$75
Out: $50/$150		 $1,500 100/90/90/60 100/90/90/60 N/A SUM5936
$1,000 SUM5940
$1,200 SUM5942
$1,500 SUM5944
$2,000 SUM5946
Plan 161 In: $50/$150
Out: $50/$150		 $1,500 100/90/90/60 100/90/90/60 N/A SUM5948
$1,000 SUM5952
$1,200 SUM5954
$1,500 SUM5956
$2,000 SUM5958
Plan 171 In: $50/$150
Out: $50/$150		 $2,000 100/90/60/60 100/90/60/60 N/A SUM6032
$1,000 SUM6036
$1,200 SUM6038
$1,500 SUM6040
$2,000 SUM6042
Plan 181 In: $25/$75
Out: $50/$150		 $2,000 100/90/90/60 100/90/90/60 N/A SUM5960
$1,000 SUM5964
$1,200 SUM5966
$1,500 SUM5968
$2,000 SUM5970
Plan 191 In: $50/$150
Out: $50/$150		 $2,000 100/90/90/60 100/90/90/60 N/A SUM5972
$1,000 SUM5976
$1,200 SUM5978
$1,500 SUM5980
$2,000 SUM5982
Plan 201 In: $25/$75
Out: $25/$75		 $5,000 100/80/80/60 100/80/80/60 N/A SUM6811
$1,000 SUM6817
$1,200 SUM6819
$1,500 SUM6812
$2,000 SUM6821

BlueDental Basic (Employer-Sponsored or Voluntary)

Plan Deductible Annual Max In-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Out-of-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Orthodontic
Lifetime
Maximum		 Dental Summary
1 In: $25/$75
Out: $50/$150		 $1,000 100/80/0 80/60/0 N/A SUM2578

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