Traditional and Preferred Dental Benefit Summaries - District of Columbia

Change Healthcare Notice

Traditional and Preferred Dental Benefit Summaries - District of Columbia

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

Spanish benefit summaries are available upon request. Please contact your CareFirst sales representative for more information.

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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Preferred (PPO) Dental 1-50

Summary of Preferred PPO Dental 1-50 Plan Options
Plan	In-Network Features	Dental Summary
Plan 1	80/50/50/50	CUT6156
Plan 2	100/80/50/50	CUT6157
Plan 3	100/80/80/50	CUT6158
Plan 4	100/80/80/50 \| $1500 ABM	CUT6159

BlueDental Preferred 1-50 - ACA Compliant (On Exchange only)

Summary of BlueDental Preferred 1-50 Plan Option
Plan	In-Network Features	Dental Summary
Plan 1	100/80/80/50	CST1973

Preferred (PPO) Dental 51+

Summary of Preferred PPO Dental 51+ Plan Options
Plan	In-Network Features	Dental Summary
Plan 1	80/50/50/50	CUT6164
Plan 2	100/80/80/50	CUT6165
Plan 3	100/80/50/50 100/80/50/50	CUT6166 SUM2348
Plan 4	100/90/90/60	CUT6167
Plan 5	100/90/60/60	CUT6168

Voluntary Preferred (PPO) Dental 1-50 & 51+

Summary of Voluntary Preferred PPO Dental Plan Options
Plan	In-Network Features	Dental Summary
Plan 1	80/50/50/50	SUM1693
Plan 2	100/80/50/50	SUM1694
Plan 3	100/80/80/50	SUM1695
Plan 4	100/80/80/50 \| $1500 ABM	SUM1696

Traditional Dental 1-50

Summary of Traditional Dental 1-50 Plan Options
Plan	Features	Dental Summary
Plan 1	80/50/50/50	CUT6138
Plan 2	100/80/50/50	CUT6139
Plan 3	100/80/80/50	CUT6140
Plan 4	100/80/80/50 \| $1500 ABM	CUT6141

BlueDental Traditional 1-50 - ACA Compliant (On Exchange only)

Summary of BlueDental Traditional 1-50 Plan Options
Plan	Features	Dental Summary
Plan 1	100/80/80/50	CST1974

Traditional Dental 51+

Summary of Traditional Dental 51+ Plan Options
Plan	Features	Dental Summary
Plan 1	80/50/50/50	CUT6146
Plan 2	100/80/80/50 100/80/80/50	CUT6147 SUM2349
Plan 3	100/80/50/50	CUT6148
Plan 4	100/90/90/60	CUT6149
Plan 5	100/90/60/60	CUT6150

Voluntary Traditional Dental 1-50 & 51+

Summary of Voluntary Traditional Dental Plan Options
Plan	Features	Dental Summary
Plan 1	80/50/50/50	SUM1701
Plan 2	100/80/50/50	SUM1702
Plan 3	100/80/80/50	SUM1703
Plan 4	100/80/80/50 \| $1500 ABM	SUM1704

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