BlueDental Plus and BlueDental Basic Benefit Summaries - Maryland

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

Plan* In-Network Out-of-Network Annual Max Dental Summary
1 100/80/80/50 100/80/80/50 $1,500 SUM2580 (No Ortho)
SUM2592 (With Ortho)
2 100/80/80/50 80/60/60/35 $1,500 SUM2581 (No Ortho)
SUM2593 (With Ortho)
3 100/80/50/50 100/80/50/50 $1,500 SUM2582 (No Ortho)
SUM2594 (With Ortho)
4 100/80/50/50 80/60/35/35 $1,500 SUM2583 (No Ortho)
SUM2595 (With Ortho)
5 100/80/80/50 100/80/80/50 $2,000 SUM2584 (No Ortho)
SUM2596 (With Ortho)
6 100/80/80/50 80/60/60/35 $2,000 SUM2585 (No Ortho)
SUM2597 (With Ortho)
7 100/80/50/50 100/80/50/50 $2,000 SUM2586 (No Ortho)
SUM2598 (With Ortho)
8 100/80/50/50 80/60/35/35 $2,000 SUM2587 (No Ortho)
SUM2599 (With Ortho)
 

 

BlueDental Plus 51+ (Employer-Sponsored or Voluntary)

* Note: Plan options 1-8 are available as both Employer-Sponsored1 or Voluntary2. Plan options 9-19 are only available as Employer-Sponsored.

Plan* In-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Out-of-Network
(Preventive & Diagnostic/
Basic/Major Surgical/
Major Restorative)		 Annual Max Orthodontic Lifetime Maximum Dental Summary
Plan 11,2 100/80/80/50 100/80/80/50 $1,500 N/A SUM2580
$800 SUM6044
$1,000 SUM6046
$1200 SUM6048
$1,500 SUM2592
$2,000 SUM6050
Plan 21,2 100/80/80/50 80/60/60/35 $1,500 N/A SUM2581
$800 SUM6052
$1,000 SUM6054
$1,200 SUM6056
$1,500 SUM2593
$2,000 SUM6058
Plan 31,2 100/80/50/50 100/80/50/50 $1,500 N/A SUM2582
$800 SUM6076
$1000 SUM6078
$1,200 SUM6080
$1,500 SUM2594
$2,000 SUM6082
Plan 41,2 100/80/50/50 80/60/35/35 $1,500 N/A SUM2583
$800 SUM6084
$1000 SUM6086
$1,200 SUM6088
$1,500 SUM2595
$2,000 SUM6090
Plan 51,2 100/80/80/50 100/80/80/50 $2,000 N/A SUM2584
$800 SUM6060
$1000 SUM6062
$1,200 SUM6064
$1,500 SUM2596
$2,000 SUM6066
Plan 61,2 100/80/80/50 80/60/60/35 $2,000 N/A SUM2585
$800 SUM6068
$1000 SUM6070
$1,200 SUM6072
$1,500 SUM2597
$2,000 SUM6074
Plan 71,2 100/80/50/50 100/80/50/50 $2,000 N/A SUM2586
$800 SUM6092
$1000 SUM6094
$1,200 SUM6096
$1,500 SUM2598
$2,000 SUM6098
Plan 81,2 100/80/50/50 80/60/35/35 $2,000 N/A SUM2587
$800 SUM6100
$1000 SUM6102
$1,200 SUM6104
$1,500 SUM2599
$2,000 SUM6106
Plan 91 100/80/50/50 100/80/50/50 $1,000 N/A SUM5984
$800 SUM5986
$1000 SUM5988
$1,200 SUM5990
$1,500 SUM5992
$2,000 SUM5994
Plan 101 100/80/80/50 100/80/80/50 $1,000 N/A SUM5912
$800 SUM5914
$1000 SUM5916
$1,200 SUM5918
$1,500 SUM5920
$2,000 SUM5922
Plan 111 100/80/50/50 100/80/50/50 $1,500 N/A SUM5996
$800 SUM5998
$1000 SUM6000
$1,200 SUM6002
$1,500 SUM6004
$2,000 SUM6006
Plan 121 100/80/80/50 100/80/80/50 $1,500 N/A SUM5924
$800 SUM5926
$1000 SUM5928
$1,200 SUM5930
$1,500 SUM5932
$2,000 SUM5934
Plan 131 100/90/60/60

100/90/60/60

 $1,500 N/A SUM6008
$800 SUM6010
$1000 SUM6012
$1,200 SUM6014
$1,500 SUM6016
$2,000 SUM6018
Plan 141 100/90/60/60 100/90/60/60 $1,500 N/A SUM6020
$800 SUM6022
$1000 SUM6024
$1,200 SUM6026
$1,500 SUM6028
$2,000 SUM6030
Plan 151 100/90/90/60 100/90/90/60 $1,500 N/A SUM5936
$800 SUM5938
$1000 SUM5940
$1,200 SUM5942
$1,500 SUM5944
$2,000 SUM5946
Plan 161 100/90/90/60 100/90/90/60 $1,500 N/A SUM5948
$800 SUM5950
$1000 SUM5952
$1,200 SUM5954
$1,500 SUM5956
$2,000 SUM5958
Plan 171 100/90/60/60 100/90/60/60 $2,000 N/A SUM6032
$800 SUM6034
$1000 SUM6036
$1,200 SUM6038
$1,500 SUM6040
$2,000 SUM6042
Plan 181 100/90/90/60 100/90/90/60 $2,000 N/A SUM5960
$800 SUM5962
$1000 SUM5964
$1,200 SUM5966
$1,500 SUM5968
$2,000 SUM5970
Plan 191 100/90/90/60 100/90/90/60 $2,000 N/A SUM5972
$800 SUM5974
$1000 SUM5976
$1,200 SUM5978
$1,500 SUM5980
$2,000 SUM5982

 

BlueDental Basic (Employer-Sponsored or Voluntary)

PlanIn-NetworkOut-of-NetworkAnnual MaxDental Summary
1 100/80/0 80/60/0 $1,000 SUM2578 (No Ortho)

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