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.

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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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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