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Traditional and Preferred Dental Benefit Summaries

Benefit summaries are now available for the health plans listed below. Please check the site frequently for summary updates.

Please note: Not all services and procedures are covered by your benefits contract. Benefit summaries are for comparison purposes only and does not create rights not given through the benefit plan.

NOTE: Employers can consult with a CareFirst account executive to explore other plan options that fit their organization's benefit needs.

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Preferred (PPO) Dental 1-50

Summary of Preferred PPO Dental 1-50 Plan Options
Plan	Deductible	Annual Max	In-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative/ Orthodontia (if applicable))	Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative/ Orthodontia (if applicable))	Orthodontic Lifetime Maximum	Dental Summary
Plan 1	In: $25/$75 Out: $50/$150	$1,000	80/50/50/50/50	60/35/35/35/35	N/A	BRC6320 (No Ortho)
Plan 1	In: $25/$75 Out: $50/$150	$1,000	80/50/50/50/50	60/35/35/35/35	$1,200	CUT6183 (With Ortho)
Plan 2	In: $25/$75 Out: $50/$150	$1,000	100/80/50/50/50	80/60/35/35/35	N/A	BRC6321 (No Ortho)
Plan 2	In: $25/$75 Out: $50/$150	$1,000	100/80/50/50/50	80/60/35/35/35	$1,200	CUT6184 (With Ortho)
Plan 3	In: $25/$75 Out: $50/$150	$1,000	100/80/80/50/50	80/60/60/35/35	N/A	BRC6322 (No Ortho)
Plan 3	In: $25/$75 Out: $50/$150	$1,000	100/80/80/50/50	80/60/60/35/35	$1,200	CUT6185 (With Ortho)
Plan 4	In: $25/$75 Out: $50/$150	$1,500	100/80/80/50/50	80/60/60/35/35	N/A	BRC6323 (No Ortho)
Plan 4	In: $25/$75 Out: $50/$150	$1,500	100/80/80/50/50	80/60/60/35/35	$1,200	CUT6186 (With Ortho)

BlueDental Preferred 1-50 - ACA Compliant

Summary of BlueDental Preferred 1-50 ACA Compliant Plan Options
Plan	Deductible	Annual Max (up to the age of 19)	In-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative)	Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative)	Dental Summary
Plan 1	In: $50/$150 Out: $100/$300	$1,000	100/80/80/50/50	80/60/60/35/35	CST1978

Preferred (PPO) Dental 51+

Summary of Preferred PPO Dental 51+ Plan Options
Plan	Deductible	Annual Max	In-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative/ Orthodontia (if applicable))	Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative/ Orthodontia (if applicable))	Orthodontic Lifetime Maximum	Dental Summary
Plan 1	In: $25/$75 Out: $50/$150	$1,000	80/50/50/50	60/35/35/35	N/A	CUT6095
Plan 1	In: $0/$0 Out: $50/$150	$1,500	80/50/50/50	60/35/35/35	N/A	BRC6328
Plan 2	In: $25/$75 Out: $50/$150	$1,000	100/80/80/50/50	80/60/60/35/35	N/A	CUT6096
					$1,000	BRC6329
					$1,200	CUT6164
Plan 2	In: $25/$75 Out: $50/$150	$1,500	100/80/80/50/50	80/60/60/35/35	N/A	SUM7780
					$1,000	CUT6165
					$1,200	SUM7781
					$1,500	SUM7782
Plan 2	In: $0/$0 Out: $50/$150	$1,000	100/80/80/50/50	80/60/60/35/35	N/A	SUM7783
Plan 2	In: $0/$0 Out: $50/$150	$1,000	100/80/80/50/50	80/60/60/35/35	$1,000	SUM7784
Plan 2	In: $0/$0 Out: $50/$150	$1,500	100/80/80/50	80/60/60/35	N/A	SUM7785
Plan 3	In: $25/$75 Out: $50/$150	$1,000	100/80/50/50/50	80/60/35/35/35	N/A	CUT6097
					$1,000	BRC6330
					$1,500	CUT6166
Plan 3	In: $25/$75 Out: $50/$150	$1,500	100/80/50/50/50	80/60/35/35/35	N/A	SUM2350
Plan 3	In: $25/$75 Out: $50/$150	$1,500	100/80/50/50/50	80/60/35/35/35	$1,500	SUM2348
Plan 4	In: $25/$75 Out: $50/$150	$1,000	100/90/90/60/50	80/80/80/50/35	N/A	CUT6098
Plan 4	In: $25/$75 Out: $50/$150	$1,000	100/90/90/60/50	80/80/80/50/35	$1,000	CUT6167
Plan 4	In: $25/$75 Out: $50/$150	$1,500	100/90/90/60/50	80/80/80/50/35	N/A	BRC6331
					$1,000	SUM7786
					$1,500	SUM7787
Plan 4	In: $0/$0 Out: $50/$150	$1,000	100/90/90/60/50	80/80/80/50/35	$1,000	CUT6466
Plan 5	In: $25/$75 Out: $50/$150	$1,500	100/90/60/60/50	80/80/50/50/35	N/A	CUT6168
Plan 5	In: $25/$75 Out: $50/$150	$1,500	100/90/60/60/50	80/80/50/50/35	$1,500	BRC6332

Voluntary Preferred (PPO) Dental 1-50 & 51+

Summary of Voluntary Preferred PPO Dental 1-50 and 51+ Plan Options
Plan	Deductible	Annual Max	In-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative)	Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative)	Orthodontic Lifetime Maximum	Dental Summary
Plan 1	In: $25/$75 Out: $50/$150	$1,000	80/50/50/50	60/35/35/35	$1,200	SUM1697
Plan 1	In: $25/$75 Out: $50/$150	$1,000	80/50/50/50	60/35/35/35	N/A	SUM1693
Plan 2	In: $25/$75 Out: $50/$150	$1,000	100/80/50/50	80/60/35/35	$1,200	SUM1698
Plan 2	In: $25/$75 Out: $50/$150	$1,000	100/80/50/50	80/60/35/35	N/A	SUM1694
Plan 3	In: $25/$75 Out: $50/$150	$1,000	100/80/80/50	80/60/60/35	$1,200	SUM1699
Plan 3	In: $25/$75 Out: $50/$150	$1,000	100/80/80/50	80/60/60/35	N/A	SUM1695
Plan 4	In: $25/$75 Out: $50/$150	$1,500	100/80/80/50	80/60/60/35	$1,200	SUM1700
Plan 4	In: $25/$75 Out: $50/$150	$1,500	100/80/80/50	80/60/60/35	N/A	SUM1696

Traditional Dental 1-50

Summary of Traditional Dental 1-50 Plan Options
Plan	Deductible	Annual Max	In-Network and Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative/ Orthodontia (if applicable))	Dental Summary
Plan	Deductible	Annual Max		Ortho	No Ortho
Plan 1	$50/$150	$1,000	80/50/50/50/50	CUT6082	BRC6302
Plan 2	$50/$150	$1,000	100/80/50/50/50	CUT6083	BRC6303
Plan 3	$50/$150	$1,000	100/80/80/50/50	CUT6084	BRC6304
Plan 4	$50/$150	$1,500	100/80/80/50/50	CUT6085	BRC6305

BlueDental Traditional 1-50 - ACA Compliant

Summary of BlueDental Traditional 1-50 ACA Compliant Plan Options
Plan	Deductible	Annual Max	In-Network and Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative)	Dental Summary
Plan 1	$50/$150	$1,500	100/80/80/50/50	CST1977

Traditional Dental 51+

Summary of Traditional Dental 51+ Plan Options
Plan	Deductible	Annual Max	In-Network and Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative/ Orthodontia (if applicable))	Orthodontic Lifetime Maximum	Dental Summary
Plan 1	$50/$150	$1,000	80/50/50/50/50	N/A	CUT6146
Plan 1	$50/$150	$1,000	80/50/50/50/50	$1,000	BRC6310
Plan 1	$50/$150	$1,500	80/50/50/50/50	N/A	CUT6090
Plan 1	$50/$150	$1,500	80/50/50/50/50	$1,500	SUM7788
Plan 2	$25/$75	$1,000	100/80/80/50/50	$1,000	SUM7789
				$1,200	SUM7790
				$1,500	SUM7791
Plan 2	$25/$75	$1,500	100/80/80/50/50	N/A	CUT6091
				$1,000	BRC6311
				$1,200	CUT6147
Plan 2	$50/$150	$1,000	100/80/80/50/50	N/A	SUM7792
				$1,000	SUM7793
				$1,200	SUM7794
				$1,500	SUM7795
Plan 2	$50/$150	$1,500	100/80/80/50/50	N/A	SUM7796
				$1,000	SUM7797
				$1,200	SUM7798
				$1,500	SUM7799
Plan 3	$50/$150	$1,000	100/80/50/50/50	N/A	CUT6092
				$1,000	BRC6312
				$1,200	CUT6148
				$1,500	SUM7800
Plan 3	$50/$150	$1,500	100/80/50/50/50	N/A	SUM7801
				$1,000	SUM7802
				$1,500	SUM7803
Plan 4	$25/$75	$1,000	100/90/90/60/50	$1,000	SUM7804
Plan 4	$25/$75	$1,500	100/90/90/60/50	$1,500	CUT6093
Plan 4	$50/$150	$1,000	100/90/90/60/50	N/A	CUT6149
Plan 4	$50/$150	$1,000	100/90/90/60/50	$1,000	BRC6313
Plan 4	$50/$150	$1,500	100/90/90/60/50	N/A	SUM7805
				$1,000	SUM7806
				$1,500	SUM7807
Plan 5	$50/$150	$1,500	100/90/60/60/50	N/A	CUT6094
				$1,000	CUT6150
				$1,500	BRC6314

Voluntary Traditional Dental 1-50 & 51+

Summary of Voluntary Traditional Dental 1-50 and 51+ Plan Options
Plan	Deductible	Annual Max	In-Network and Out-of-Network (Preventive & Diagnostic/ Basic/Major Surgical/ Major Restorative)	Orthodontic Lifetime Maximum	Dental Summary
Plan 1	$50/$150	$1,000	80/50/50/50	$1,200	SUM1705
Plan 1	$50/$150	$1,000	80/50/50/50	N/A	SUM1701
Plan 2	$50/$150	$1,000	100/80/50/50	$1,200	SUM1706
Plan 2	$50/$150	$1,000	100/80/50/50	N/A	SUM1702
Plan 3	$50/$150	$1,000	100/80/80/50	$1,200	SUM1707
Plan 3	$50/$150	$1,000	100/80/80/50	N/A	SUM1703
Plan 4	$50/$150	$1,500	100/80/80/50	$1,200	SUM1708
Plan 4	$50/$150	$1,500	100/80/80/50	N/A	SUM1704

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