Dental

Dental coverage helps you maintain a healthy smile with preventive care, basic services, and major procedures. You can visit any licensed dentist, but you’ll save the most when you use an in-network provider who has agreed to discounted rates. Out-of-network dentists may charge more than the plan’s allowed amount, and you may be responsible for the difference. Most plans cover preventive services—such as exams, cleanings, and X-rays—at 100% when you stay in-network, making regular checkups an easy way to protect your oral health and avoid costly issues down the road.

Mutual of Omaha Dental

In-Network Benefit Highlights

Deductible (Individual/Family)
$XX/$XX

Out-of-Pocket Max (Individual/Family)
$XX/$XX

Preventive Care
$XX

Primary Care Visit
$XX

Specialist Visit
$XX

Urgent Care
$XX

Emergency Room
$XX

Benefit Highlights
In-Network

Deductible (Individual/Family)
$25/$75

Annual Plan Maximum  (Individual/Family)
$3,000

Preventive Care
$0

Basic Services
10% coinsurance after deductible

Major Procedures
40% coinsurance after deductible

Orthodontia (Children)
50% up to a lifetime maximum benefit of $1,000

Out-of-Network

Deductible (Individual/Family)
$25/$75

Annual Plan Maximum (Individual/Family)
$3,000

Preventive Care
$0

Basic Services
15% coinsurance after deductible

Major Procedures
50% coinsurance after deductible

Orthodontia (Children)
50% up to a lifetime maximum benefit of $1,000

Plan Cost

Employee Only: $6.49

Employee and Spouse/DP: $71.52

Employee and Child(ren): $87.21

Employee and Family: $170.59

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