Topaz Dental IndemnityPlus
The indemnity plan that does not rely on a network. Members receive the same benefit levels both in and out-of-network, but members receive additional savings on out-of-pocket when they see one of 155,000 dentists within the network.
Members also receive the BEST Life special dental accident benefit. That means if something happens to sound and natural teeth, they will get $1,000 per accident that is not counted toward the calendar year maximum.
| Calendar Year Maximum | $2,500 |
| $2,000 | |
| $1,500 | |
| $1,000 |
| Induvidual Calendar Year Deductible
3 per family max |
$0, $25, $50, $75 or $100 Waived on preventive services. |
| Class I: Preventive Services
Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants. |
100% |
| Class II: Basic Services
Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery. |
90% |
| Class III: Major Services
Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures. |
60% |
| Oral Surgery | Class II or Class III |
| Endodontics | Class II or Class III |
| Periodontics | Class II or Class III |
| Waiting Periods | 12 month waiting period applies to major and orthodontic services. Wavied for qulalifying groups. |
| Special Dental Accident Benefit | $1,000 maximum per accident to sound, natural teeth. |
| Out-of-Network Reimbursement | UCR at 80th or 90th Percentile or MAC |
| Orthodontics Option | 50% |
| Child Only Orthodontia Benefit Option Dependent children through age 18 Dependent children through age 18 |
$1,000 Lifetime / $500 Calendar Year Maximum or $1,500 Lifetime / $750 Calendar Year Maximum |
| Adult/Child Orthodontia Benefit Option | $1,000 Lifetime / $500 Calendar Year Maximum or $1,500 Lifetime / $750 Calendar Year Maximum |
| Children's Good Vision Benefit
(Included with Orthodontia) |
Covers 50% of UCR for an eye exam once every 12 months for children through age 18. |
| Calendar Year Maximum | $2,000 |
| $1,500 | |
| $1,000 |
| Induvidual Calendar Year Deductible
3 per family max |
$0, $25, $50, $75 or $100 Waived on preventive services. |
| Class I: Preventive Services
Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants. |
100% |
| Class II: Basic Services
Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery. |
80% |
| Class III: Major Services
Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures. |
50% |
| Oral Surgery | Class II or Class III |
| Endodontics | Class II or Class III |
| Periodontics | Class II or Class III |
| Waiting Periods | 12 month waiting period applies to major and orthodontic services. Waived for qualifying groups. |
| Special Dental Accident Benefit | $1,000 maximum per accident to sound, natural teeth. |
| Out-of-Network Reimbursement | UCR at 80th or 90th Percentile or MAC |
| Orthodontics Option | 50% |
| Child Only Orthodontia Benefit Option Dependent children through age 18 |
$1,000 Lifetime / $500 Calendar Year Maximum or $1,500 Lifetime / $750 Calendar Year Maximum |
| Adult/Child Orthodontia Benefit Option | $1,000 Lifetime / $500 Calendar Year Maximum or $1,500 Lifetime / $750 Calendar Year Maximum |
| Child Good Vision Benefit
Included with Orthodontia. |
Covers 50% of UCR for an eye exam once every 12 months for children through age 18. |
| Calendar Year Maximum | $1,500 |
| $1,000 | |
| $500 |
| Induvidual Calendar Year Deductible
3 per family max |
$0, $25, $50, $75 or $100 Waived on preventive services. |
| Class I: Preventive Services
Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants. |
100% |
| Class II: Basic Services
Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery. |
80% |
| Class III: Major Services
Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures. |
0% |
| Oral Surgery | Class II or Class III |
| Endodontics | Class II or Class III |
| Periodontics | Class II or Class III |
| Waiting Periods
Wavied for qulalifying groups. |
None |
| Special Dental Accident Benefit | $1,000 maximum per accident to sound, natural teeth. |
| Out-of-Network Reimbursement | UCR at 80th or 90th Percentile or MAC |
| Orthodontics Option | Not Offered |
| Child Only Orthodontia Benefit Option Dependent children through age 18 |
Not Offered |
| Adult/Child Orthodontia Benefit Option | Not Offered |
| Child Good Vision Benefit
Included with Orthodontia. |
Not Offered |
| Calendar Year Maximum | $1,500 |
| $1,000 | |
| $500 |
| Induvidual Calendar Year Deductible
3 per family max |
$0, $25, $50, $75 or $100 Waived on preventive services. |
| Class I: Preventive Services
Routine oral exam, cleanings, fluoride treatment for children, bitewing x-rays, panoramic/full mouth x-rays, sealants. |
100% |
| Class II: Basic Services
Fillings (amalgam, porcelain and plastic), anterior and posterior composites, anesthesia (general or IV sedation), emergency palliative treatment, space maintainers for children, limited oral exam, pathology, oral surgery. |
50% |
| Class III: Major Services
Crowns and gold fillings, inlays, onlays and pontics, fixed bridges, implants, complete and partial dentures. |
0% |
| Oral Surgery | Class II or Class III |
| Endodontics | Class II or Class III |
| Periodontics | Class II or Class III |
| Waiting Periods
Wavied for qulalifying groups. |
None |
| Special Dental Accident Benefit | $1,000 maximum per accident to sound, natural teeth. |
| Out-of-Network Reimbursement | UCR at 80th or 90th Percentile or MAC |
| Orthodontics Option | Not Offered |
| Child Only Orthodontia Benefit Option Dependent children through age 18 |
Not Offered |
| Adult/Child Orthodontia Benefit Option | Not Offered |
| Child Good Vision Benefit
Included with Orthodontia. |
Not Offered |
Available in
UT Only.