For Members

Dental

Getting regular dental care is important not only for your teeth and gums, but your overall health.

• No annual benefit maximum for non-Medicare covered Diagnostic and Preventive services, such as oral exams, cleanings, and X-rays. (Frequency and visit limits apply.)
• $0 deductible and $20 office visit copay for non-Medicare covered Diagnostic and Preventive services. Coinsurance applies for Out-of-Network Services.
• Members must use a Dominion Dental participating dental provider for in-network coverage to apply.
• Refer to the Dental Code Quick Reference Guide for administrative coverage details, covered dental procedures and associated dental codes, and frequency and visit limits.
• Comprehensive services not included. Available with optional dental rider for an additional monthly fee.
• Refer to your Evidence of Coverage for details on covered services.
• Visit dominiondentists.com/healthteamadvantage to find a Dominion Dental provider.
• For claims questions, call Dominion Dental at 833-208-3848.

Comprehensive Dental Rider

Here are some important reminders if you signed up for the Comprehensive Dental Rider when you enrolled in the Vitality Plan.

• There is a $45 monthly premium for this rider.
• Covers fillings, dentures, partials, crowns, gum treatments, and more.
• $100 per year deductible. Member coinsurance varies based on service.
• $1,500 annual benefit maximum (combined for In- and Out-of-Network Services).

Refer to your Evidence of Coverage for details on covered services.