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MEMBER DENTAL AND VISION BENEFITS.Home > Compare Plans: eDental
Which plan is right for you?
Below you can compare coverage for Dominion's plans. For more details, you can view the plan documents at the bottom of the chart. The "Percentages" tab below shows how much each of the plans cover for each of the listed procedures. Click the "Copayments" tab to see an in-network comparison that shows how much you would pay for these procedures for each of these plans. Rates for the plans are based on your county and state. To view information regarding the vision plan, click here. For more information, please contact our Customer Service at 877.681.3879.
| Benefit Features | Choice PPO Basic | |||
| Office Visit | N/A | |||
| Deductibles | $50 per member (max per family $150)1 | |||
| Annual Maximums | $1,000 per insured person | |||
| Waiting Periods | None | |||
| Receive Care From | Choice PPO network dentist or any licensed dentist | |||
| States Available | All | |||
| Procedures and Covered Services |
Year 12 In/Out Network |
Year 22 In/Out Network |
Year 32 In/Out Network |
|
| I. Diagnostic & Preventive | ||||
| Comprehensive Oral Exam | 100% | 90% | 100% | 90% | 100% | 90% | |
| Bitewing X-Rays (2 Films) | 100% | 90% | 100% | 90% | 100% | 90% | |
| Teeth Cleaning (Adult) | 100% | 90% | 100% | 90% | 100% | 90% | |
| Topical Fluoride for Children | 100% | 90% | 100% | 90% | 100% | 90% | |
| II. Basic Restorative | ||||
| Full and panoramic X-rays | 50% | 30% | 60% | 50% | 80% | 70% | |
| Amalgam filling (silver) | 50% | 30% | 60% | 50% | 80% | 70% | |
| Composite filling (white) | 50% | 30% | 60% | 50% | 80% | 70% | |
| Extraction, erupted tooth | 50% | 30% | 60% | 50% | 80% | 70% | |
| III. Major Restorative | ||||
| Crown (Porcelain/Metal) | 15% | 10% | 25% | 20% | 50% | 40% | |
| Bridges | 15% | 10% | 25% | 20% | 50% | 40% | |
| Complete Denture | 15% | 10% | 25% | 20% | 50% | 40% | |
| Relining of dentures | 15% | 10% | 25% | 20% | 50% | 40% | |
| Periodontics (root planing and therapy) | 15% | 10% | 25% | 20% | 50% | 40% | |
| Endodontics (root canals) | 15% | 10% | 25% | 20% | 50% | 40% | |
| Oral Surgery (extraction of impacted teeth) | 15% | 10% | 25% | 20% | 50% | 40% | |
| IV. Orthodontics | ||||
| Adults and Children | 0% | 0% | 0% | 0% | 0% | 0% | |
| Plan Document | ||||
Additional Plans
| Benefit Features | Select Plan Premium3,4 | Choice PPO Premium | Elite ePPO Basic4 | ||
| Office Visit | $10 | None | None | ||
| Deductibles | None | $50 per member (max per family $150)5 | $25 per member (max per member $75)5 | ||
| Annual Maximums | None | $1,500 per insured person | $1,500 per insured person | ||
| Waiting Periods | None | Yes6 | None | ||
| Receive Care From | Select Plan Network Dentist | Choice PPO network dentist or any licensed dentist | Elite ePPO Network Dentist | ||
| States Available | DC, DE, MD, NJ, PA, VA | All | DC, MD, PA, VA | ||
| Procedures and Covered Services | In/Out Network | ||||
| I. Diagnostic & Preventive | |||||
| Comprehensive Oral Exam | 100% | 100% | 90% | 100% | ||
| Bitewing X-Rays (2 Films) | 100% | 100% | 90% | 100% | ||
| Teeth Cleanings (two per year) | 100% | 100% | 90% | 100% | ||
| Topical Fluoride for Children | 100% | 100% | 90% | 100% | ||
| II. Basic Restorative | |||||
| Full and panoramic X-rays | 85% | 100% | 90% (Class I) |
100% (Class I) |
||
| Amalgam filling (silver) | 85% | 80% | 70% | 90% | ||
| Composite filling (white) | 75% | 80% | 70% | 90% | ||
| Extraction, erupted tooth | 75% | 80% | 70% | 80% | ||
| III. Major Restorative | |||||
| Crown (Porcelain/Metal) | 60% | 50% | 40% | 60% | ||
| Bridges | 65% | 50% | 40% | 60% | ||
| Complete Denture | 70% | 50% | 40% | 75% | ||
| Relining of dentures | 70% | 50% | 40% | 80% | ||
| Periodontics (root planing and therapy) | 70% | 50% | 40% | 70% | ||
| Endodontics (root canals) | 70% | 50% | 40% | 50% | ||
| Oral surgery (extraction of impacted teeth) | 70% | 50% | 40% | 70% | ||
| IV. Orthodontics | |||||
| Adults and Children | 45% | 0% | 0% | 0% | ||
| Plan Document | Select Plan Premium | Elite ePPO Basic | |||
1 Deductibles apply to all services
2 Year 1 benefits apply during the subscriber's first 12 months of continuous coverage. Year 2 benefits apply during the subscriber's second 12 months of continuous coverage. Year 3 benefits apply during the subscriber's third 12 months of continuous coverage.
3 Managed care plan with exclusive network, fixed member copayments, no annual maximum dollar limits, no waiting periods and no deductibles. Select Plan limited in NJ to individuals who reside in Camden, Cumberland or Gloucester County.
4 Approximate percentage of coverage based on the Context4Healthcare's 80th percentile. Based on zip 223. A specific fee schedule applies and will be sent with your membership card.
5 Deductibles apply to basic care and major restorative care.
6 There are no waiting periods for diagnostic and preventive care or basic care. To be eligible for major restorative care, you must have completed 6 (six) months of continuous coverage. Waiting period credit will be given for the length of time an insured was covered under each benefit classification under the current employer's prior dental coverage.
Which plan is right for you?
Below you can compare in-network coverage for Dominion's plans. For more details, you can view the plan documents at the bottom of the chart. The "Copayments" tab below shows how much you would pay for these procedures for each of these plans. Click the "Percentages" tab to see a comparison that shows how much each of the plans cover for each of the listed procedures. Rates for the plans are based on your county and state. To view information regarding the vision plan, click here. For more information, please contact our Customer Service at 877.681.3879.
| Benefit Features | Choice PPO Basic | ||||
| Office Visit | N/A | ||||
| Deductibles | $50 per member (max per family $150)1 | ||||
| Annual Maximums | $1,000 per insured person | ||||
| Waiting Periods | None | ||||
| Receive Care From | Choice PPO network dentist or any licensed dentist | ||||
| States Available | All | ||||
| Procedures and Covered Services | Avg. Cost Without Plan2 |
You Pay Year 12,3 |
You Pay Year 22,3 |
You Pay Year 32,3 |
|
| I. Diagnostic & Preventive | |||||
| Comprehensive Oral Exam |
$71 |
$0 | $0 | $0 | |
| Bitewing X-Rays (2 Films) | $61 | $0 | $0 | $0 | |
| Teeth Cleaning (Adult) | $120 | $0 | $0 | $0 | |
| Topical Fluoride for Children | $49 | $0 | $0 | $0 | |
| II. Basic Restorative | |||||
| Filling (3-Surface/Silver) | $338 | $169 | $135 | $68 | |
| Complete Series X-Rays | $189 | $0 | $0 | $0 | |
| III. Major Restorative | |||||
| Crown (Porcelain/Metal) | $1,291 | $1,097 | $968 | $646 | |
| Complete Denture | $2,164 | $1,839 | $1,623 | $1,082 | |
| Root Canal (Anterior Tooth) | $1,134 | $964 | $851 | $567 | |
| Perio Scaling/Root Planing | $342 | $291 | $257 | $171 | |
| IV. Orthodontics | |||||
| Adults | $6,420 | Not Covered | Not Covered | Not Covered | |
| Children | $6,233 | Not Covered | Not Covered | Not Covered | |
| Plan Document | |||||
Additional Plans
| Benefit Features | Select Plan Premium4 | Choice PPO Premium | Elite ePPO Basic | |||
| Office Visit | $10 | None | None | |||
| Deductibles | None | $50 per adult (adult max $150)5 | $25 per adult (adult max $75)5 | |||
| Annual Maximums | None | $1,500 per insured person | $1,500 per insured person | |||
| Waiting Periods | None | Yes6 | None | |||
| Receive Care From | Select Plan Network Dentist | Choice PPO network dentist or any licensed dentist | Elite ePPO Network Dentist | |||
| States Available | DC, DE, MD, NJ, PA, VA | All | DC, MD, PA, VA | |||
| Procedures and Covered Services |
Avg. Cost Without Plan2 |
You Pay1 | You Pay2 | You Pay | ||
| I. Diagnostic & Preventive | ||||||
| Comprehensive Oral Exam | $71 | $0 | $0 | $0 | ||
| Bitewing X-Rays (4 Films) | $61 | $0 | $0 | $0 | ||
| Teeth Cleaning (Adult) | $120 | $0 | $0 | $0 | ||
| Topical Fluoride for Children | $49 | $0 | $0 | $0 | ||
| II. Basic Restorative | ||||||
| Filling (3-Surface Silver) | $338 | $58 | $68 | $40 | ||
| Complete Series X-Rays | $189 | $26 | $0 | $0 | ||
| III. Major Restorative | ||||||
| Crown (Porcelain/Metal) | $1,291 | $495 | $646 | $570 | ||
| Complete Denture | $2,164 | $664 | $1,082 | $560 | ||
| Root Canal (Anterior Tooth) | $1,134 | $325 | $567 | $550 | ||
| Perio Scaling/Root Planing | $342 | $105 | $171 | $97 | ||
| IV. Orthodontics | ||||||
| Adults | $6,420 | $3,658 | Not Covered | Not Covered | ||
| Children | $6,233 | $3,422 | Not Covered | Not Covered | ||
| Plan Document | Select Plan Premium | Choice PPO Premium | Elite ePPO Basic | |||
1 Deductibles apply to all services.
2 Approximate costs and payment amounts based on the Context4Healthcare's 80th percentile. Based on zip 223. A specific fee schedule applies and will be sent with your membership card.
3 Year 1 benefits apply during the subscriber's first 12 months of continuous coverage. Year 2 benefits apply during the subscriber's second 12 months of continuous coverage. Year 3 benefits apply during the subscriber's third 12 months of continuous coverage.
4 Managed care plan with exclusive network, fixed member copayments, no annual maximum dollar limits, no waiting periods and no deductibles. Select Plan limited in NJ to individuals who reside in Camden, Cumberland or Gloucester County.
5 Deductibles apply to basic care and major restorative care.
6 There are no waiting periods for diagnostic and preventive care and basic care. To be eligible for major restorative care, you must have completed 6 (six) months of continuous coverage. Waiting period credit will be given for the length of time an insured was covered under each benefit classification under the current employer's prior dental coverage.
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