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BlueDental Plus and BlueDental Basic Benefit Summaries - Virginia

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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Plan*In-NetworkOut-of-NetworkAnnual MaxDental Summary
1 100/80/50 100/80/50 $1,500 SUM2616 (No Ortho)
SUM2628 (With Ortho)
2 100/80/50 80/60/35 $1,500 SUM2617 (No Ortho)
SUM2629 (With Ortho)
3 100/80/50 100/80/50 $1,500 SUM2618 (No Ortho)
SUM2630 (With Ortho)
4 100/80/50 80/60/35 $1,500 SUM2619 (No Ortho)
SUM2631 (With Ortho)
5 100/80/50 100/80/50 $2,000 SUM2620 (No Ortho)
SUM2632 (With Ortho)
6 100/80/50 80/60/35 $2,000 SUM2621 (No Ortho)
SUM2633 (With Ortho)
7 100/80/50 100/80/50 $2,000 SUM2622 (No Ortho)
SUM2634 (With Ortho)
8 100/80/50 80/60/35 $2,000 SUM2623 (No Ortho)
SUM2635 (With Ortho)

*Plans 1, 2, 5 and 6: Major Surgical Services have the same coinsurance as Basic Services. Plans 3, 4, 7, and 8: Major Surgical Services have the same coinsurance as Major Restorative Services.

Plan*In-NetworkOut-of-NetworkAnnual MaxDental Summary
1 100/80/50 100/80/50 $1,500 SUM2640 (No Ortho)
SUM2646 (With Ortho)
2 100/80/50 80/60/35 $1,500 SUM2641 (No Ortho)
SUM2647 (With Ortho)
3 100/80/50 100/80/50 $1,500 SUM2642 (No Ortho)
SUM2648 (With Ortho)
4 100/80/50 80/60/35 $1,500 SUM2643 (No Ortho)
SUM2649 (With Ortho)
5 100/80/50 100/80/50 $2,000 N/A
6 100/80/50 80/60/35 $2,000 N/A
7 100/80/50 100/80/50 $2,000 N/A
8 100/80/50 80/60/35 $2,000 N/A

*Plans 1, 2, 5 and 6: Major Surgical Services have the same coinsurance as Basic Services. Plans 3, 4, 7, and 8: Major Surgical Services have the same coinsurance as Major Restorative Services.

PlanIn-NetworkOut-of-NetworkAnnual MaxDental Summary
1 100/80/0 80/60/0 $1,000 SUM2579 (No Ortho)

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