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Premier Elite
Plan Type DPPO
Coinsurance N/A
Deductible $50 per person (combined basic and major services)
Annual Maximum Benefit We pay up to: $2,000 per person, per calendar year
Office Visit
Find Dentists 		N/A
Primary Benefits
Teeth Cleanings 0% Coinsurance for day one
Restorative Dentistry/Fillings 50% Coinsurance for day one, 35% Coinsurance after policy year one, 20% Coinsurance after policy year two
Oral Surgery 85% Coinsurance after 6-month waiting period, 50% Coinsurance after policy year one, 40% Coinsurance after policy year two
Extractions 50% Coinsurance for day one, 35% Coinsurance after policy year one, 20% Coinsurance after policy year two
X-Rays 0% Coinsurance for day one (Bitewing - limited to 1 series per calendar year; Full mount panoramic - limited to 1 per 36 months)
Crowns 85% Coinsurance after 6-month waiting period, 50% Coinsurance after policy year one, 40% Coinsurance after policy year two
Root Canals 85% Coinsurance after 6-month waiting period, 50% Coinsurance after policy year one, 40% Coinsurance after policy year two
Periodontics 85% Coinsurance after 6-month waiting period, 50% Coinsurance after policy year one, 40% Coinsurance after policy year two
Dentures 85% Coinsurance after 6-month waiting period, 50% Coinsurance after policy year one, 40% Coinsurance after policy year two
Topical Fluoride 0% Coinsurance for day one
Sealant 0% Coinsurance for day one
Bridges 85% Coinsurance after 6-month waiting period, 50% Coinsurance after policy year one, 40% Coinsurance after policy year two
Endodontics 85% Coinsurance after 6-month waiting period, 50% Coinsurance after policy year one, 40% Coinsurance after policy year two
Additional Information
A.M. Best Rating A+ as of 12/14/2023
Electronic Signature for Application Available Yes
Details and documents about this plan
View Plan Brochure Exclusions and Limitations

Important notices and disclaimers

  • The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
  • The benefits listed may be contingent on your use of physicians, hospitals, dentists and services within the specific insurance company's provider network.
  • The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
  • The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history (pursuant to state law of residence), the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.

Carrier specific notices, disclaimers and fees

  • UnitedHealthcare - Golden Rule Insurance Company, a UnitedHealthcare company, is the underwriter of these plans. This product is administered by Dental Benefit Providers, Inc.
  • UnitedHealthcare - This screen is intended only as general information. It presents only a brief overview of some of the standard benefits of the product(s) shown. Optional benefits may be available for additional premium.
  • UnitedHealthcare - Before you apply, please use the link(s) provided to download and review the product information for a more complete explanation of benefits, exclusions (including any that may apply to preexisting conditions), limitations, terms under which the product(s) may not be renewed or benefits may be reduced, and any state variations applicable to any of these items.
  • UnitedHealthcare - You must meet our eligibility requirements in order to become insured, which may include medical underwriting. There is no coverage until we inform you in writing that your application has been processed and approved.
  • UnitedHealthcare - To be considered for reimbursement, expenses must qualify as "covered expenses" under the policy, and are also subject to all other policy provisions, such as reasonable and customary or eligible expense limits, or whether or not they were medically necessary.
  • UnitedHealthcare - Estimated Premium shown is based on the information you provided, and is subject to change based on the product(s) you select, optional benefits you select (if any), and other factors. We shall exclusively determine the premium actually required, and the effective date of any coverage issued.
  • UnitedHealthcare - These plans pay non-network provider benefits based on the network negotiated rate. Non-network dentists can bill a patient for any remaining amount up to the billed charge.