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Dominion National is actively monitoring the developments regarding the evolving Coronavirus (COVID-19) and potential impacts to our clients and employees. Click here for more information on the proactive measures we are taking to prevent the spread of coronavirus and ensure the continuity of our business operations. We also encourage you to visit the CDC website and ADA website for up-to-date information.

SMILE. WE'VE GOT YOU COVERED.

MEMBER DENTAL AND VISION BENEFITS.

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 Service Center 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

Choice PPO Basic

 

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, 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

Choice PPO 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. 
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 Service Center 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 $374
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   

Choice PPO Basic

 

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, 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 mailed 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. 
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.